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Pi Z, Johnson JA, Meng W, Phillips M, Schumacher WA, Bostwick JS, Gargalovic PS, Onorato JM, Generaux CN, Wang T, He Y, Gordon DA, Wexler RR, Finlay HJ. Identification of 6-Hydroxypyrimidin-4(1 H)-one-3-carboxamides as Potent and Orally Active APJ Receptor Agonists. ACS Med Chem Lett 2021; 12:1766-1772. [PMID: 34795866 DOI: 10.1021/acsmedchemlett.1c00385] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/18/2021] [Indexed: 01/01/2023] Open
Abstract
The apelin receptor (APJ) is a significant regulator of cardiovascular function and is involved in heart failure and other cardiovascular diseases. (Pyr1)apelin-13 is one of the endogenous agonists of the APJ receptor. Administration of (Pyr1)apelin-13 increases cardiac output in preclinical models and humans. Recently we disclosed clinical lead BMS-986224 (1), a C3 oxadiazole pyridinone APJ receptor agonist with robust pharmacodynamic effects similar to (Pyr1)apelin-13 in an acute rat pressure-volume loop model. Herein we describe the structure-activity relationship of the carboxamides as oxadiazole bioisosteres at C3 of the pyridinone core and C5 of the respective pyrimidinone core. This study led to the identification of structurally differentiated 6-hydroxypyrimidin-4(1H)-one-3-carboxamide 14a with pharmacodynamic effects comparable to those of compound 1.
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Affiliation(s)
- Zulan Pi
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - James A. Johnson
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Wei Meng
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Monique Phillips
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - William A. Schumacher
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Jeffrey S. Bostwick
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Peter S. Gargalovic
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Joelle M. Onorato
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Claudia N. Generaux
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Tao Wang
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Yan He
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - David A. Gordon
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Ruth R. Wexler
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
| | - Heather J. Finlay
- Research and Development, Bristol Myers Squibb Company, P.O. Box 5400, Princeton, New Jersey 08543-5400, United States
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Chen C, Zhu XY, Li D, Lin Q, Zhou K. Clinical efficacy and safety of spironolactone in patients with resistant hypertension: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21694. [PMID: 32846786 PMCID: PMC7447418 DOI: 10.1097/md.0000000000021694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We conducted a meta-analysis to summarize all available evidence from randomized controlled trial studies regarding the clinical efficacy and safety of spironolactone in patients with resistant hypertension (RH) and provided a quantitative assessment. METHODS A systematic search of PubMed, Web of Science, Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI) databases through December 8, 2019, was performed. Randomized controlled trials randomized controlled trials meeting inclusion criteria were included to assess the effect of the addition of spironolactone on office blood pressure (BP), 24-hour ambulatory BP or adverse events in RH patients. RESULTS Twelve trials, which enrolled a total of 1655 patients, were included in this meta-analysis. In comparison with placebo, spironolactone significantly reduced office BP (office SBP, weighted mean difference [WMD] = -20.14, 95% CI = -31.17 to -9.12, P < .001; office DBP WMD = -5.73, 95% CI = -8.13 to -3.33, P < .001) and 24-hour ambulatory BP (ASBP, WMD = -10.31, 95% CI = -12.86 to -7.76, P < .001; ADBP, WMD = -3.94, 95% CI = -5.50 to -2.37, P < .001). Compared with alternative drugs, spironolactone treatment in RH patients significantly decreased 24-hour ambulatory BP (ASBP, WMD = -6.98, 95% CI = -12.66 to -1.30, P < .05; ADBP, WMD = -3.03, 95% CI = -5.21 to -0.85, P < .001). CONCLUSION This meta-analysis fully evaluated the antihypertensive effect of spironolactone compared with placebo, alternative drugs, renal nerve denervation and no treatment. Spironolactone can result in a substantial BP reduction in patients with RH at 3 months.
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Affiliation(s)
- Cong Chen
- Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing
| | - Xue-Ying Zhu
- Shandong University of Traditional Chinese Medicine
| | - Dong Li
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Lin
- Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing
| | - Kun Zhou
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Greenfield RH. Heart Failure. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hezzell MJ, Boswood A, López-Alvarez J, Lötter N, Elliott J. Treatment of dogs with compensated myxomatous mitral valve disease with spironolactone-a pilot study. J Vet Cardiol 2017; 19:325-338. [PMID: 28734620 DOI: 10.1016/j.jvc.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/25/2017] [Accepted: 06/15/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Spironolactone improves outcome in dogs with advanced myxomatous mitral valve disease (MMVD). Its efficacy in preclinical MMVD is unknown. The hypothesis was the administration of spironolactone to dogs with compensated MMVD demonstrating risk factors for poorer prognosis will decrease the rate of disease progression. The aim was to provide pilot data to evaluate preliminary effects and sample size calculation for a definitive clinical trial. ANIMALS Twenty-five client-owned dogs with MMVD with at least one of the following; left atrial to aortic ratio (LA:Ao) ≥ 1.5, normalized left ventricular internal diameter in diastole ≥ 1.6), N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 550 pmol/L, cardiac troponin I > 0.025 ng/mL. METHODS Prospective, single-center, equally randomized, placebo-controlled, double-blinded, parallel grouped pilot study. No dogs were receiving medications for cardiac disease before the enrollment. RESULTS Twelve dogs received placebo; 13 received spironolactone. One dog in the spironolactone group died suddenly, 1 developed congestive heart failure, and 2 received suboptimal spironolactone doses. At enrollment, NT-proBNP was significantly higher in the spironolactone group (p=0.005). Left atrial to aortic ratio (p=0.002) and left ventricular internal diameter in diastole (p=0.005) increased over time in the placebo group, but not the spironolactone group; the change did not differ significantly between groups. The change in biomarker concentrations did not differ significantly between groups; there was a tendency toward an increase in NT-proBNP over time in the placebo group. Enrollment of 76 dogs would be necessary to demonstrate a difference in the change in LA:Ao over 6 months between the groups. CONCLUSIONS Preliminary results support undertaking a larger clinical trial of treatment of dogs with preclinical MMVD with spironolactone.
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Affiliation(s)
- M J Hezzell
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK.
| | - A Boswood
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J López-Alvarez
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - N Lötter
- Department of Veterinary Basic Sciences, The Royal Veterinary College, London, UK
| | - J Elliott
- Department of Veterinary Basic Sciences, The Royal Veterinary College, London, UK
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Lax A, Sanchez-Mas J, Asensio-Lopez MC, Fernandez-Del Palacio MJ, Caballero L, Garrido IP, Pastor-Perez FJ, Januzzi JL, Pascual-Figal DA. Mineralocorticoid Receptor Antagonists Modulate Galectin-3 and Interleukin-33/ST2 Signaling in Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction. JACC-HEART FAILURE 2015; 3:50-58. [DOI: 10.1016/j.jchf.2014.07.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/30/2014] [Accepted: 07/11/2014] [Indexed: 12/31/2022]
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Kaldara E, Sanoudou D, Adamopoulos S, Nanas JN. Outpatient management of chronic heart failure. Expert Opin Pharmacother 2014; 16:17-41. [PMID: 25480690 DOI: 10.1517/14656566.2015.978286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Heart failure (HF) treatment attracts a share of intensive research because of its poor HF prognosis. In the past decades, the prognosis of HF has improved considerably, mainly as a consequence of the progress that has been made in the pharmacological management of HF. AREAS COVERED This article reviews the outpatient pharmacological management of chronic HF due to left ventricular systolic dysfunction and offers recommendations on the use of various drugs. In addition, the present article attempts to provide practical therapeutic algorithms based on current clinical strategies. EXPERT OPINION Continued research directed toward identifying factors associated with high pharmacotherapy guideline adherence and understanding of variants that influence response to drugs will hopefully halt or reverse the major pathophysiological mechanisms involved in this syndrome.
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Affiliation(s)
- Elisabeth Kaldara
- University of Athens, Medical School, 3rd Cardiology Department , Mikras Asias 67, 11527 Attiki, Athens , Greece +30 2108236877 ; +30 2107789901 ;
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Alexandre J, Beygui F, Puddu PE, Manrique A, Rouet R, Milliez P. Electrophysiological and antiarrhythmic properties of potassium canrenoate during myocardial ischemia-reperfusion. J Cardiovasc Pharmacol Ther 2014; 20:313-21. [PMID: 25389106 DOI: 10.1177/1074248414557036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 09/23/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Recent clinical studies have reported the potential benefit of an early mineralocorticoid receptor (MR) blockade with potassium canrenoate (PC) on ventricular arrhythmias (VAs) occurrence in patients experiencing an ST-segment elevation myocardial infarction (STEMI). However, most of the electrophysiological properties of PC demonstrated to date have been investigated in normoxic conditions, and therefore, in vitro experiments during an acute myocardial ischemia-reperfusion were lacking. MATERIALS AND METHODS We used rabbit in vitro models and standard microelectrode technique to assess the electrophysiological impact of PC during myocardial ischemia-reperfusion, including right ventricle mimicking the "border zone" existing between normal and ischemic/reperfused areas (1 µmol/L, 10 and 100 nmol/L), isolated right ventricle, and sinoatrial node (SAN) experiments (1 µmol/L, respectively). RESULTS During ischemia-reperfusion, acute superfusion of PC 100 nmol/L prevented the increase in action potential (AP) duration at 90% of repolarization (APD90) dispersion between ischemic and nonischemic areas and in VAs occurrence induced by aldosterone 10 nmol/L (86 ± 3 vs 114 ± 4 milliseconds for aldosterone alone, P < .05). Potassium canrenoate also induced conduction blocks and significantly decreased Vmax during simulated ischemia (from 25 ± 5 to 12 ± 4, 14 ± 3, and 14 ± 5 V/s, respectively, for PC 1 µmol/L, 100, and 10 nmol/L, P < .05). Potassium canrenoate 1 µmol/L demonstrated cycle length (CL)-dependent effects on APD90 and on Vmax, and it also reduced SAN beating CL (from 446 ± 28 to 529 ± 24 millisecond, P < .05). CONCLUSION Our experimental study highlights new evidence for an antiarrhythmic impact of PC during myocardial ischemia-reperfusion via multiple channels modulation. These results are in line with recent clinical trials suggesting that an early MR blockade in STEMI may be preventive of VAs.
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Affiliation(s)
- Joachim Alexandre
- Department of Cardiology, CHU de Caen, Caen, France Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
| | - Farzin Beygui
- Department of Cardiology, CHU de Caen, Caen, France Université de Caen Basse-Normandie, Medical School, Caen, France
| | | | - Alain Manrique
- Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France Université de Caen Basse-Normandie, Medical School, Caen, France
| | - René Rouet
- Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France Université de Caen Basse-Normandie, Medical School, Caen, France
| | - Paul Milliez
- Department of Cardiology, CHU de Caen, Caen, France Université de Caen Basse-Normandie, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France Université de Caen Basse-Normandie, Medical School, Caen, France
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Rademaker MT, Charles CJ, Nicholls MG, Richards AM. Interactions of Enhanced Urocortin 2 and Mineralocorticoid Receptor Antagonism in Experimental Heart Failure. Circ Heart Fail 2013; 6:825-32. [DOI: 10.1161/circheartfailure.112.000205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background—
Mineralocorticoid receptor antagonists (MRAs) have become established therapy in heart failure (HF). Urocortin 2 (Ucn2) is a novel peptide with potential in the treatment of this disease. The present study investigated the interactions of acute administration of Ucn2 and an MRA in experimental HF.
Methods and Results—
Ucn2 and an MRA (canrenoic acid [CA]) were infused for 4 hours, both singly and together, in 8 sheeps with pacing-induced HF. Ucn2, when administered as an adjunct to CA, further improved hemodynamic indices relative to that achieved by CA alone, producing additional increases in cardiac output and decreases in left atrial pressure and peripheral resistance but without eliciting a supplementary reduction in arterial pressure. Ucn2 cotreatment reversed CA-induced rises in circulating aldosterone levels, and also significantly reduced plasma renin activity, angiotensin II, and vasopressin concentrations. Although both CA and Ucn2 infusion produced a diuresis and natriuresis, responses with Ucn2 and Ucn+CA were 2- to 3-fold greater than that elicited by separate CA. Ucn2 cotherapy additionally increased urine potassium and creatinine excretion. In contrast to the rise in plasma potassium induced by CA, Ucn2 cotreatment reduced potassium concentrations.
Conclusions—
Ucn2 cotreatment with an MRA in HF further improved hemodynamics relative to that achieved by CA alone, while also reducing plasma renin activity, angiotensin II, aldosterone and vasopressin levels, and enhancing renal function. Importantly, Ucn2 prevented CA-induced rises in plasma potassium. These data demonstrate a favorable profile of effects with short-term adjunct Ucn2 therapy and an MRA in HF.
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Affiliation(s)
- Miriam T. Rademaker
- From the Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Christopher J. Charles
- From the Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - M. Gary Nicholls
- From the Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - A. Mark Richards
- From the Christchurch Heart Institute, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
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Zannad F, Gattis Stough W, Rossignol P, Bauersachs J, McMurray JJV, Swedberg K, Struthers AD, Voors AA, Ruilope LM, Bakris GL, O'Connor CM, Gheorghiade M, Mentz RJ, Cohen-Solal A, Maggioni AP, Beygui F, Filippatos GS, Massy ZA, Pathak A, Piña IL, Sabbah HN, Sica DA, Tavazzi L, Pitt B. Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: integrating evidence into clinical practice. Eur Heart J 2012; 33:2782-95. [PMID: 22942339 DOI: 10.1093/eurheartj/ehs257] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HF-REF), and mild-to-severe symptoms, and in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. These clinical benefits are observed in addition to those of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers. The morbidity and mortality benefits of MRAs may be mediated by several proposed actions, including antifibrotic mechanisms that slow heart failure progression, prevent or reverse cardiac remodelling, or reduce arrhythmogenesis. Both eplerenone and spironolactone have demonstrated survival benefits in individual clinical trials. Pharmacologic differences exist between the drugs, which may be relevant for therapeutic decision making in individual patients. Although serious hyperkalaemia events were reported in the major MRA clinical trials, these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up. When used appropriately, MRAs significantly improve outcomes across the spectrum of patients with HF-REF.
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Affiliation(s)
- Faiez Zannad
- INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, France.
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Heart Failure. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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