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García Aguilar H, Gorenflo M, Ivy DD, Moledina S, Castaldi B, Ishida H, Cześniewicz P, Kusa J, Miera O, Pattathu J, Weng K, Ablonczy L, Apitz C, Katona M, Kurosaki K, Pulido T, Yamagishi H, Yasuda K, Cisternas G, Goth M, Lippert S, Radomskyj A, Saleh S, Willmann S, Wirsching G, Bonnet D, Beghetti M. Riociguat in children with pulmonary arterial hypertension:the PATENT‐CHILD study. Pulm Circ 2022; 12:e12133. [PMID: 36186721 PMCID: PMC9485817 DOI: 10.1002/pul2.12133] [Citation(s) in RCA: 6] [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: 12/16/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022] Open
Abstract
Riociguat, a soluble guanylate cyclase stimulator, is approved for treatment of adults with pulmonary arterial hypertension (PAH). The safety, tolerability, and pharmacokinetics (PK) of oral riociguat in a pediatric population with PAH was assessed in PATENT–CHILD (NCT02562235), a multicenter, single‐arm, 24‐week, open‐label, Phase 3 study. Patients aged 6–17 years in World Health Organization functional class (WHO‐FC) I–III treated with stable endothelin receptor antagonists and/or prostacyclin analogs received riociguat equivalent to 0.5–2.5 mg three times daily in adults, as either oral pediatric suspension or tablets, based on bodyweight. Primary outcomes were safety, tolerability, and PK of riociguat. Twenty‐four patients (mean age 12.8 years), 18 of whom were in WHO‐FC II, were enrolled. Adverse events (AEs), mostly mild or moderate, were reported in 20 patients (83%). Four patients (17%) experienced a serious AE; all resolved by study end and two (8%) were considered study‐drug related. Hypotension was reported in three patients and hemoptysis in one (all mild/moderate intensity). Riociguat plasma concentrations in pediatric patients were consistent with those published in adult patients. From baseline to Week 24, mean ± standard deviation increase in 6‐minute walking distance was 23 ± 69 m (n = 19), and mean decrease in NT‐proBNP was –66 ± 585 pg/ml (n = 14). There was no change in WHO‐FC. Two patients experienced clinical worsening events of hospitalization for right heart failure. PK results confirmed a suitable riociguat dosing strategy for pediatric patients with PAH. The data suggest an acceptable safety profile with potential efficacy signals.
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Affiliation(s)
| | - Matthias Gorenflo
- Department of Pediatric Cardiology and Congenital Cardiology Heidelberg University Medical Centre Heidelberg Germany
| | - D Dunbar Ivy
- Division of Cardiology, Department of Pediatrics University of Colorado School of Medicine, Children's Hospital Colorado Aurora CO USA
| | - Shahin Moledina
- Cardiology Department Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Biagio Castaldi
- Dipartimento di Pediatria, Azienda Ospedaliera di Padova Padova Italy
| | - Hidekazu Ishida
- Department of Pediatrics Osaka University Graduate School of Medicine Osaka Japan
| | - Paweł Cześniewicz
- Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center Wroclaw Poland
| | - Jacek Kusa
- Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center Wroclaw Poland
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center, Berlin Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology and Congenital Cardiology Heidelberg University Medical Centre Heidelberg Germany
| | - Ken‐Pen Weng
- Department of Pediatrics, Congenital Structural Heart Disease Center, Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Laszlo Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology Budapest Hungary
| | - Christian Apitz
- Division of Pediatric Cardiology University Children's Hospital Ulm Ulm Germany
| | - Marta Katona
- Department of Pediatrics Albert Szent‐Györgyi Medical Center, University of Szeged Hungary
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Tomas Pulido
- Clinical Research Department Ignacio Chavez National Heart Institute Mexico City, Mexico
| | | | - Kazushi Yasuda
- Department of Pediatric Cardiology Aichi Children's Health and Medical Center Aichi Japan
| | | | | | | | | | | | | | | | - Damien Bonnet
- M3C‐Necker, Hôpital Necker Enfants malades APHP Université de Paris Paris France
| | - Maurice Beghetti
- Paediatric Cardiology Unit University Hospitals of Geneva Geneva Switzerland
- Centre Universitaire Romand De Cardiologie Et Chirurgie Cardiaque Pédiatrique, Children's University Hospital, University of Geneva and Lausanne Geneva Switzerland
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Vericiguat Modulates Osteoclast Differentiation and Bone Resorption via a Balance between VASP and NF- κB Pathways. Mediators Inflamm 2022; 2022:1625290. [PMID: 35757109 PMCID: PMC9225892 DOI: 10.1155/2022/1625290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Bone homeostasis has been a dynamic equilibrium between osteoclasts (OCs) and osteoblasts (OBs). However, excessive activation of OCs could disturb the bone homeostasis. As a result, effective medical interventions for patients are greatly demanding. NO/guanylate cyclase (GC)/cGMP signaling cascade has been previously reported to regulate bone metabolism, and GC plays a significantly critical role. Vericiguat, as a novel oral soluble guanylate cyclase (sGC) stimulator, has been firstly reported in 2020 to treat patients with heart failure. Nevertheless, the biological effects of Vericiguat on the function of OCs have not yet been explored. In this present study, we found that Vericiguat with the concentration between 0 and 8 μM was noncytotoxic to bone marrow-derived monocyte-macrophage lineage (BMMs). Vericiguat could enhance the differentiation of OCs at concentration of 500 nM, whereas it inhibited OC differentiation at 8 μM. In addition, Vericiguat also showed dual effects on OC fusion and bone resorption in a dose-dependent manner. Furthermore, a molecular assay suggested that the dual regulatory effects of Vericiguat on OCs were mediated by the bidirectional activation of the IκB-α/NF-κB signaling pathway. Taken together, our present study demonstrated the dual effects of Vericiguat on the formation of functional OCs. The regulatory effects of Vericiguat on OCs were achieved by the bidirectional modulation of the IκB-α/NF-κB signaling pathway, and a potential balance between the IκB-α/NF-κB signaling pathway and sGC/cGMP/VASP may exist.
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Domingo LT, Ivy DD, Abman SH, Grenolds AM, MacLean JT, Breaux JA, Minford KJ, Frank BS. Novel use of riociguat in infants with severe pulmonary arterial hypertension unable to wean from inhaled nitric oxide. Front Pediatr 2022; 10:1014922. [PMID: 36533232 PMCID: PMC9751701 DOI: 10.3389/fped.2022.1014922] [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: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Riociguat, an oral soluble guanylate cyclase stimulator, has been approved for use in adults with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension. However, there is limited data on its therapeutic use in children. CASE PRESENTATION We report the case of two infants with severe suprasystemic pulmonary hypertension who were successfully treated with riociguat after failure to wean off inhaled nitric oxide (iNO) despite combination PAH therapy. Case 1 is a 6-month-old term male with TBX4 deletion who presented with severe hypoxemic respiratory failure and severe PAH immediately after birth. Initial cardiac catheterization showed PVRi 15.5 WU*m2. Marked hypoxemia and PAH persisted despite aggressive therapy with sildenafil, bosentan, intravenous treprostinil, and milrinone. The infant required high doses of inhaled nitric oxide (60 ppm) and manifested significant post-ductal hypoxemia and hemodynamic instability with any attempt at weaning. After discontinuation of sildenafil, initiation, and very slow uptitration of riociguat, the patient was able to maintain hemodynamic stability and wean from nitric oxide over 6 weeks with persistently severe but not worsened pulmonary hypertension. Case 2 is a 4-month-old term male with compound heterozygous SLC25A26 mutation and severe pulmonary hypertension. Initial cardiac catheterization showed PVRi 28.2 WU*m2. After uptitration of sildenafil, bosentan, and IV treprostinil, serial echocardiograms continued to demonstrate near-systemic pulmonary hypertension. He failed multiple attempts to wean off typical doses of iNO (10-20 ppm) over the following weeks with tachypnea, hypoxemia, and worsening pulmonary hypertension on echocardiogram despite continued aggressive combination targeted therapy. After a 24-h sildenafil washout, he was initiated and uptitrated on riociguat with concomitant, successful wean of nitric oxide over one week that was well tolerated. No serious adverse effects in the titration period were observed. CONCLUSION Riociguat may be considered as an adjuvant therapeutic agent in selected children with severe PAH who are poorly responsive to sildenafil therapy and unable to wean from iNO.
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Affiliation(s)
- L T Domingo
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake, UT, United States
| | - D D Ivy
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - S H Abman
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - A M Grenolds
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - J T MacLean
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - J A Breaux
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - K J Minford
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake, UT, United States
| | - B S Frank
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
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Kim SM, Yuen T, Iqbal J, Rubin MR, Zaidi M. The NO-cGMP-PKG pathway in skeletal remodeling. Ann N Y Acad Sci 2020; 1487:21-30. [PMID: 32860248 DOI: 10.1111/nyas.14486] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Abstract
The nitric oxide (NO)-cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG) pathway plays a critical role in skeletal homeostasis. Preclinical data using NO and its donors and genetically modified mice demonstrated that NO was required in bone remodeling and partly mediated the anabolic effects of mechanical stimuli and estrogen. However, the off-target effects and tachyphylaxis of NO limit its long-term use, and previous clinical trials using organic nitrates for osteoporosis have been disappointing. Among the other components in the downstream pathway, targeting cGMP-specific phosphodiesterase to promote the NO-cGMP-PKG signal is a viable option. There are growing in vitro and in vivo data that, among many other PDE families, PDE5A is highly expressed in skeletal tissue, and inhibiting PDE5A using currently available PDE5A inhibitors might increase the osteoanabolic signal and protect the skeleton. These preclinical data open the possibility of repurposing PDE5A inhibitors for treating osteoporosis. Further research is needed to address the primary target bone cell of PDE5A inhibition, the contribution of direct and indirect effects of PDE5A inhibition, and the pathophysiological changes in skeletal PDE5A expression in aging and hypogonadal animal models.
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Affiliation(s)
- Se-Min Kim
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tony Yuen
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jameel Iqbal
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mishaela R Rubin
- Department of Medicine, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mone Zaidi
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Kim SM, Taneja C, Perez-Pena H, Ryu V, Gumerova A, Li W, Ahmad N, Zhu LL, Liu P, Mathew M, Korkmaz F, Gera S, Sant D, Hadelia E, Ievleva K, Kuo TC, Miyashita H, Liu L, Tourkova I, Stanley S, Lizneva D, Iqbal J, Sun L, Tamler R, Blair HC, New MI, Haider S, Yuen T, Zaidi M. Repurposing erectile dysfunction drugs tadalafil and vardenafil to increase bone mass. Proc Natl Acad Sci U S A 2020; 117:14386-14394. [PMID: 32513693 PMCID: PMC7321982 DOI: 10.1073/pnas.2000950117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We report that two widely-used drugs for erectile dysfunction, tadalafil and vardenafil, trigger bone gain in mice through a combination of anabolic and antiresorptive actions on the skeleton. Both drugs were found to enhance osteoblastic bone formation in vivo using a unique gene footprint and to inhibit osteoclast formation. The target enzyme, phosphodiesterase 5A (PDE5A), was found to be expressed in mouse and human bone as well as in specific brain regions, namely the locus coeruleus, raphe pallidus, and paraventricular nucleus of the hypothalamus. Localization of PDE5A in sympathetic neurons was confirmed by coimmunolabeling with dopamine β-hydroxylase, as well as by retrograde bone-brain tracing using a sympathetic nerve-specific pseudorabies virus, PRV152. Both drugs elicited an antianabolic sympathetic imprint in osteoblasts, but with net bone gain. Unlike in humans, in whom vardenafil is more potent than tadalafil, the relative potencies were reversed with respect to their osteoprotective actions in mice. Structural modeling revealed a higher binding energy of tadalafil to mouse PDE5A compared with vardenafil, due to steric clashes of vardenafil with a single methionine residue at position 806 in mouse PDE5A. Collectively, our findings suggest that a balance between peripheral and central actions of PDE5A inhibitors on bone formation together with their antiresorptive actions specify the osteoprotective action of PDE5A blockade.
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Affiliation(s)
- Se-Min Kim
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029;
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Charit Taneja
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Helena Perez-Pena
- Department of Pharmaceutical and Biological Chemistry, University College London School of Pharmacy, WC1N 1AX London, United Kingdom
| | - Vitaly Ryu
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Anisa Gumerova
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Wenliang Li
- Department of Pharmaceutical and Biological Chemistry, University College London School of Pharmacy, WC1N 1AX London, United Kingdom
| | - Naseer Ahmad
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Ling-Ling Zhu
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Peng Liu
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Mehr Mathew
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Funda Korkmaz
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Sakshi Gera
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Damini Sant
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Elina Hadelia
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Kseniia Ievleva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Reproductive Health, Scientific Center for Family Health and Human Reproduction Problems, 664003 Irkutsk, Russian Federation
| | - Tan-Chun Kuo
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Hirotaka Miyashita
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Li Liu
- Department of Pathology, Pittsburgh Veterans Affairs Healthcare System, Pittsburgh, PA 15240
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261
| | - Irina Tourkova
- Department of Pathology, Pittsburgh Veterans Affairs Healthcare System, Pittsburgh, PA 15240
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261
| | - Sarah Stanley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Daria Lizneva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Jameel Iqbal
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Li Sun
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Ronald Tamler
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Harry C Blair
- Department of Pathology, Pittsburgh Veterans Affairs Healthcare System, Pittsburgh, PA 15240
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261
| | - Maria I New
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029;
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Shozeb Haider
- Department of Pharmaceutical and Biological Chemistry, University College London School of Pharmacy, WC1N 1AX London, United Kingdom
| | - Tony Yuen
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Mone Zaidi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
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Targeting heme-oxidized soluble guanylate cyclase to promote osteoblast function. Drug Discov Today 2019; 25:422-429. [PMID: 31846712 DOI: 10.1016/j.drudis.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022]
Abstract
The enzyme soluble guanylate cyclase (sGC) plays an essential part in the nitric oxide (NO) signaling pathway by binding to the prosthetic heme group; thereby catalyzing the synthesis of cyclic guanosine monophosphate (cGMP)-dependent protein kinases. Impaired NO-sGC-cGMP signaling could lead to osteoblast apoptosis by mechanisms involving the oxidative-stress-induced shift of the redox state of the reduced heme to oxidized sGC, leading to diminished heme binding to the enzyme and rendering the sGC unresponsive to NO. Targeting oxidized sGC to enhance cGMP production could restore proliferation and differentiation of osteoblasts into osteocytes. Here, the potential role of sGC activators of an oxidized or heme-free sGC as a target for promoting osteoblast function is reviewed and strategies for delivering drugs to bone are identified.
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Wang L, Jia H, Tower RJ, Levine MA, Qin L. Analysis of short-term treatment with the phosphodiesterase type 5 inhibitor tadalafil on long bone development in young rats. Am J Physiol Endocrinol Metab 2018; 315:E446-E453. [PMID: 29920215 PMCID: PMC6230700 DOI: 10.1152/ajpendo.00130.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cyclic GMP (cGMP) is an important intracellular regulator of endochondral bone growth and skeletal remodeling. Tadalafil, an inhibitor of the phosphodiesterase (PDE) type 5 (PDE5) that specifically hydrolyzes cGMP, is increasingly used to treat children with pulmonary arterial hypertension (PAH), but the effect of tadalafil on bone growth and strength has not been previously investigated. In this study, we first analyzed the expression of transcripts encoding PDEs in primary cultures of chondrocytes from newborn rat epiphyses. We detected robust expression of PDE5 as the major phosphodiesterase hydrolyzing cGMP. Time-course experiments showed that C-type natriuretic peptide increased intracellular levels of cGMP in primary chondrocytes with a peak at 2 min, and in the presence of tadalafil the peak level of intracellular cGMP was 37% greater ( P < 0.01) and the decline was significantly attenuated. Next, we treated 1-mo-old Sprague Dawley rats with vehicle or tadalafil for 3 wk. Although 10 mg·kg-1·day-1 tadalafil led to a significant 52% ( P < 0.01) increase in tissue levels of cGMP and a 9% reduction ( P < 0.01) in bodyweight gain, it did not alter long bone length, cortical or trabecular bone properties, and histological features. In conclusion, our results indicate that PDE5 is highly expressed in growth plate chondrocytes, and short-term tadalafil treatment of growing rats at doses comparable to those used in children with PAH has neither obvious beneficial effect on long bone growth nor any observable adverse effect on growth plate structure and trabecular and cortical bone structure.
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Affiliation(s)
- Luqiang Wang
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
- Department of Orthopaedics, Shandong University Qilu Hospital, Shandong University , Jinan , China
| | - Haoruo Jia
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
- Department of Orthopaedics, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, China
| | - Robert J Tower
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Michael A Levine
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
- Division of Endocrinology and Diabetes and the Center for Bone Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Ling Qin
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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Donda K, Zambrano R, Moon Y, Percival J, Vaidya R, Dapaah-Siakwan F, Luo S, Duncan MR, Bao Y, Wang L, Qin L, Benny M, Young K, Wu S. Riociguat prevents hyperoxia-induced lung injury and pulmonary hypertension in neonatal rats without effects on long bone growth. PLoS One 2018; 13:e0199927. [PMID: 29990355 PMCID: PMC6038999 DOI: 10.1371/journal.pone.0199927] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common and serious chronic lung disease of premature infants. Severe BPD complicated with pulmonary hypertension (PH) increases the mortality of these infants. Riociguat is an allosteric soluble guanylate cyclase stimulator and is approved by the FDA for treating PH in adults. However, it has not been approved for use in neonates due to concern for adverse effects on long bone growth. To address this concern we investigated if administration of riociguat is beneficial in preventing hyperoxia-induced lung injury and PH without side effects on long bone growth in newborn rats. Newborn rats were randomized to normoxia (21% O2) or hyperoxia (85% O2) exposure groups within 24 hours of birth, and received riociguat or placebo by once daily intraperitoneal injections during continuous normoxia or hyperoxia exposure for 9 days. In the hyperoxia control group, radial alveolar count, mean linear intercept and vascular density were significantly decreased, the pathological hallmarks of BPD, and these were accompanied by an increased inflammatory response. There was also significantly elevated vascular muscularization of peripheral pulmonary vessels, right ventricular systolic pressure and right ventricular hypertrophy indicating PH. However, administration of riociguat significantly decreased lung inflammation, improved alveolar and vascular development, and decreased PH during hyperoxia by inducing cGMP production. Additionally, riociguat did not affect long bone growth or structure. These data indicate that riociguat is beneficial in preventing hyperoxia-induced lung injury and PH without affecting long bone growth and structure and hence, suggests riociguat may be a potential novel agent for preventing BPD and PH in neonates.
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Affiliation(s)
- Keyur Donda
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Ronald Zambrano
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Younghye Moon
- Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Justin Percival
- Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Ruben Vaidya
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Fredrick Dapaah-Siakwan
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Shihua Luo
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Matthew R. Duncan
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Yong Bao
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Luqing Wang
- Department of Orthopedic Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ling Qin
- Department of Orthopedic Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Merline Benny
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Karen Young
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
| | - Shu Wu
- Pediatrics and Batchelor Children’s Research Institute, University of Miami School of Medicine, Miami, Florida, United States of America
- * E-mail:
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9
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Kalyanaraman H, Schall N, Pilz RB. Nitric oxide and cyclic GMP functions in bone. Nitric Oxide 2018; 76:62-70. [PMID: 29550520 PMCID: PMC9990405 DOI: 10.1016/j.niox.2018.03.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 01/24/2023]
Abstract
Nitric oxide plays a central role in the regulation of skeletal homeostasis. In cells of the osteoblastic lineage, NO is generated in response to mechanical stimulation and estrogen exposure. Via activation of soluble guanylyl cyclase (sGC) and cGMP-dependent protein kinases (PKGs), NO enhances proliferation, differentiation, and survival of bone-forming cells in the osteoblastic lineage. NO also regulates the differentiation and activity of bone-resorbing osteoclasts; here the effects are largely inhibitory and partly cGMP-independent. We review the skeletal phenotypes of mice deficient in NO synthases and PKGs, and the effects of NO and cGMP on bone formation and resorption. We examine the roles of NO and cGMP in bone adaptation to mechanical stimulation. Finally, we discuss preclinical and clinical data showing that NO donors and NO-independent sGC activators may protect against estrogen deficiency-induced bone loss. sGC represents an attractive target for the treatment of osteoporosis.
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Affiliation(s)
- Hema Kalyanaraman
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652, USA
| | - Nadine Schall
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652, USA
| | - Renate B Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652, USA.
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Nicorandil inhibits osteoclast differentiation in vitro. Eur J Pharmacol 2016; 793:14-20. [DOI: 10.1016/j.ejphar.2016.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 01/03/2023]
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