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Kameshima S, Nakamura Y, Uehara K, Kodama T, Yamawaki H, Nishi K, Okano S, Niijima R, Kimura Y, Itoh N. Effects of a Soluble Guanylate Cyclase Stimulator Riociguat on Contractility of Isolated Pulmonary Artery and Hemodynamics of U46619-Induced Pulmonary Hypertension in Dogs. Vet Sci 2023; 10:vetsci10020159. [PMID: 36851463 PMCID: PMC9960282 DOI: 10.3390/vetsci10020159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Soluble guanylate cyclase (sGC) stimulator riociguat is a relatively novel therapeutic agent for pulmonary hypertension (PH) in human medicine. Riociguat induces endothelium-independent pulmonary artery (PA) relaxation by directly activating the sGC-cyclic guanosine-3',5'-monophosphate (cGMP) pathway in muscle cells. Although riociguat may be effective in the treatment of dogs with refractory PH, basic studies on its clinical application in veterinary medicine are lacking. The present study aimed to explore the effects of riociguat on the contractility of an isolated canine PA and the hemodynamics of dogs with acute PH. In an isolated endothelium-denuded canine PA, the effects of riociguat on endothelin (ET)-1-induced contraction and cGMP levels were investigated using the Magnus method and ELISA, respectively. The effect of riociguat on the hemodynamics of the thromboxane A2 analog U46619-induced PH model dog was examined by invasive catheterization. Riociguat increased cGMP levels and reduced ET-1-induced contraction of the isolated PA. Riociguat inhibited the U46619-induced elevation of PA pressure and pulmonary vascular resistance and increased cardiac output, but it had no effect on basal systemic blood pressure. These results demonstrate for the first time that riociguat can inhibit the elevation of PA pressure through PA relaxation via an endothelium-independent increase in cGMP in dogs with PH.
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Affiliation(s)
- Satoshi Kameshima
- Laboratory of Small Animal Internal Medicine 1, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
- Correspondence: ; Tel.: +81-176-23-4371
| | - Yuki Nakamura
- Laboratory of Small Animal Internal Medicine 1, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Kenji Uehara
- Laboratory of Small Animal Internal Medicine 1, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Tomoko Kodama
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Hideyuki Yamawaki
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Kotaro Nishi
- Laboratory of Small Animal Surgery 2, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Shozo Okano
- Laboratory of Small Animal Surgery 2, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Ryo Niijima
- Small Animal Teaching Hospital, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Yuya Kimura
- Laboratory of Small Animal Internal Medicine 1, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
| | - Naoyuki Itoh
- Laboratory of Small Animal Internal Medicine 1, School of Veterinary Medicine, Kitasato University, Higashi 23 Bancho 35-1, Towada 034-8628, Aomori, Japan
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Therapeutic augmentation of NO-sGC-cGMP signalling: lessons learned from pulmonary arterial hypertension and heart failure. Heart Fail Rev 2022; 27:1991-2003. [PMID: 35437713 DOI: 10.1007/s10741-022-10239-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 01/14/2023]
Abstract
The nitric oxide (NO)-guanylate cyclase (GC)-cyclic guanosine monophosphate (cGMP) pathway plays an important role in cardiovascular, pulmonary and renal function. Phosphodiesterase-5 inhibitors (PDE-5i) inhibit cGMP degradation, whereas both soluble guanylate cyclase (sGC) stimulators and sGC activators directly increase sGC. PDE-5i (e.g. sildenafil, tadalafil) and sGC stimulators (e.g. riociguat, vericiguat) have been extensively used in pulmonary artery hypertension (PAH) and heart failure (HF). PDE-5i have also been used in end-stage HF before and after left ventricular (LV) assist device (LVAD) implantation. Augmentation of NO-GC-cGMP signalling with PDE-5i causes selective pulmonary vasodilation, which is highly effective in PAH but may have controversial, potentially adverse effects in HF, including pre-LVAD implant due to device unmasking of PDE-5i-induced RV dysfunction. In contrast, retrospective analyses have demonstrated that PDE-5i have beneficial effects when initiated post LVAD implant due to the improved haemodynamics of the supported LV and the pleiotropic actions of these compounds. sGC stimulators, in turn, are effective both in PAH and in HF due to their balanced pulmonary and systemic vasodilation, and as such they are preferable to PDE-5i if the use of a pulmonary vasodilator is needed in HF patients, including those listed for LVAD implantation. Regarding the effectiveness of PDE-5i and sGC stimulators when initiated post LVAD implant, these two groups of compounds should be tested in a randomized control trial.
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Rødland L, Rønning L, Kildal AB, How OJ. The β 3 Adrenergic Receptor Antagonist L-748,337 Attenuates Dobutamine-Induced Cardiac Inefficiency While Preserving Inotropy in Anesthetized Pigs. J Cardiovasc Pharmacol Ther 2021; 26:714-723. [PMID: 34551626 PMCID: PMC8547236 DOI: 10.1177/10742484211048762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Excessive myocardial oxygen consumption (MVO2) is considered a limitation for catecholamines, termed oxygen cost of contractility. We hypothesize that increased MVO2 induced by dobutamine is not directly related to contractility but linked to intermediary myocardial metabolism. Furthermore, we hypothesize that selective β3 adrenergic receptor (β3AR) antagonism using L-748,337 prevents this. In an open-chest pig model, using general anesthesia, we assessed cardiac energetics, hemodynamics and arterial metabolic substrate levels at baseline, ½ hour and 6 hours after onset of drug infusion. Cardiac efficiency was assessed by relating MVO2 to left ventricular work (PVA; pressure–volume area). Three groups received dobutamine (5 μg/kg/min), dobutamine + L-748,337 (bolus 50 μg/kg), or saline for time-matched controls. Cardiac efficiency was impaired over time with dobutamine infusion, displayed by persistently increased unloaded MVO2 from ½ hour and 47% increase in the slope of the PVA–MVO2 relation after 6 hours. Contractility increased immediately with dobutamine infusion (dP/dtmax; 1636 ± 478 vs 2888 ± 818 mmHg/s, P < 0.05) and persisted throughout the protocol (2864 ± 1055 mmHg/s, P < 0.05). Arterial free fatty acid increased gradually (0.22 ± 0.13 vs 0.39 ± 0.30 mM, P < 0.05) with peak levels after 6 hours (1.1 ± 0.4 mM, P < 0.05). By combining dobutamine with L-748,337 the progressive impairment in cardiac efficiency was attenuated. Interestingly, this combined treatment effect occurred despite similar alterations in cardiac inotropy and substrate supply. We conclude that the extent of cardiac inefficiency following adrenergic stimulation is dependent on the duration of drug infusion, and β3AR blockade may attenuate this effect.
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Affiliation(s)
- Lars Rødland
- Cardiovascular Research Group, Institute of Medical Biology, Faculty of Health Sciences, 8016UiT-The Arctic University of Norway, Tromsø, Norway
| | - Leif Rønning
- Cardiovascular Research Group, Institute of Medical Biology, Faculty of Health Sciences, 8016UiT-The Arctic University of Norway, Tromsø, Norway
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, 60519University Hospital of North Norway, Tromsø, Norway
| | - Ole-Jakob How
- Cardiovascular Research Group, Institute of Medical Biology, Faculty of Health Sciences, 8016UiT-The Arctic University of Norway, Tromsø, Norway
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Naesheim T, How OJ, Myrmel T. The effect of Riociguat on cardiovascular function and efficiency in healthy, juvenile pigs. Physiol Rep 2020; 8:e14562. [PMID: 32918535 PMCID: PMC7507463 DOI: 10.14814/phy2.14562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of pulmonary hypertension. Its effect on cardiometabolic efficiency is unknown. A potential cardiac energy sparing effect of this drug could imply a positive prognostic effect, particularly in patients with right heart failure from pulmonary hypertension. METHOD We infused Riociguat in six healthy juvenile pigs and measured the integrated cardiovascular effect and myocardial oxygen consumption. To assess the interplay with NO-blockade on cardiac function and efficiency we also administered the NO-blocker L- NAME to the animals after Riociguat. RESULTS AND DISCUSSION Infusion of 100 µg/kg Riociguat gave modest systemic vasodilatation seen as a drop in coronary and systemic vascular resistance of 36% and 26%, respectively. Right and left ventriculoarterial coupling index (Ees/Ea), stroke work efficiency (SWeff), and the relationship between left ventricular myocardial oxygen consumption (MVO2 ) and total mechanical work (pressure-volume area; PVA) were unaffected by Riociguat. In contrast, systemic and pulmonary vasoconstriction induced by L-NAME (15 mg/kg) shifted the Ees/Ea ratio toward reduced SWeff in both systemic and pulmonary circulation. However, there was no surplus oxygen consumption, that was measured by the MVO2 /PVA relationship after L-NAME in Riociguat-treated pigs. This suggests that Riociguat can reduce the NO-related cardiometabolic inefficiency previously observed by blocking the NO pathway.
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Affiliation(s)
- Torvind Naesheim
- Cardiovascular Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Anesthesiology, University Hospital North Norway, Tromsø, Norway
| | - Ole-Jakob How
- Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Truls Myrmel
- Cardiovascular Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway
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