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He C, Mao Y, Wan H. Preclinical evaluation of chemically reactive metabolites and mitigation of bioactivation in drug discovery. Drug Discov Today 2023; 28:103621. [PMID: 37201781 DOI: 10.1016/j.drudis.2023.103621] [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: 12/20/2022] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
The formation of reactive metabolites (RMs) is thought to be one of the pathogeneses for some idiosyncratic adverse drug reactions (IADRs) which are considered one of the leading causes of some drug attritions and/or recalls. Minimizing or eliminating the formation of RMs via chemical modification is a useful tactic to reduce the risk of IADRs and time-dependent inhibition (TDI) of cytochrome P450 enzymes (CYPs). The RMs should be carefully handled before making a go-no-go decision. Herein, we highlight the role of RMs in the occurrence of IADRs and CYP TDI, the risk of structural alerts, the approaches of RM assessment at the discovery stage and strategies to minimize or eliminate RM liability. Finally, some considerations for developing a RM-positive drug candidate are suggested.
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Affiliation(s)
- Chunyong He
- Department of DMPK/Tox, Shanghai Hengrui Pharmaceutical, No. 279 Wenjing Road, Shanghai 200245, China.
| | - Yuchang Mao
- Department of DMPK/Tox, Shanghai Hengrui Pharmaceutical, No. 279 Wenjing Road, Shanghai 200245, China
| | - Hong Wan
- Department of DMPK/Bioanalysis, Shanghai Medicilon, No. 585 Chuanda Road, Shanghai 201299, China.
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Hu A, Liu Q, Ouyang J. Identification and characterization of the metabolites of moscatilin in mouse, rat, dog, monkey and human hepatocytes by LC-Orbitrap-MS/MS combined with diagnostic fragment ions and accurate mass measurements. Biomed Chromatogr 2023; 37:e5573. [PMID: 36529812 DOI: 10.1002/bmc.5573] [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: 11/24/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Moscatilin, a bibenzyl derivative from the stem of Dendrobium loddigesii, has been shown to have anticancer activity. The aim of this study was to identify and characterize the possible in vitro metabolites of moscatilin generated from hepatocytes. The metabolites generated in the hepatocytes of mouse, rat, dog, monkey and human were identified and characterized employing ultra-high-performance liquid chromatography coupled with quadrupole Orbitrap tandem mass spectrometry (LC-Orbitrap-MS/MS) based on diagnostic fragment ions and accurate mass measurements. A total of 18 metabolites were identified, among which seven were phase I and 11 were phase II metabolites. The plausible structures of the metabolites and the probable biotransformation pathways were proposed based on the diagnostic fragment ions, chemical formula and mass fragmentation pattern, as well as the accurate masses. The majority of phase I metabolites were generated by demethylation and hydroxylation, while phase II metabolites were mainly generated by glucuronidation, glutathione conjugation and sulfation. Our study first expounded the metabolites of moscatilin in mouse, rat, dog, monkey and human hepatocytes and provided a foundation for a further pharmacokinetic and toxicity study. More importantly, LC-Orbitrap-MS/MS combined with diagnostic fragment ions and accurate mass measurements has been proved to be an effective method for the rapid identification of bibenzyl derivatives and their metabolites.
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Affiliation(s)
- Aizhen Hu
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Qingwang Liu
- Institute of Heath and Medical Technology, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, Anhui Province, China
| | - Jing Ouyang
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
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Zolty R. Pulmonary arterial hypertension specific therapy: The old and the new. Pharmacol Ther 2020; 214:107576. [PMID: 32417272 DOI: 10.1016/j.pharmthera.2020.107576] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 02/08/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a vascular disorder associated with high morbidity and mortality rate and is characterized by pulmonary vascular remodeling and increased pulmonary vascular resistance, ultimately resulting in right ventricular failure and death. Over the past few decades, significant advances in the understanding of the epidemiology, pathogenesis, and pathophysiology of pulmonary arterial hypertension have occured. This has led to the development of disease specific treatment including prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators. These therapies significantly improve exercise capacity, quality of life, pulmonary hemodynamics, but none of the current treatments are actually curative and long-term prognosis remains poor. Thus, there is a clear need to develop new therapies. Several potential pharmacologic agents for the treatment of pulmonary arterial hypertension are under clinical development and some promising results with these treatments have been reported. These agents include tyrosine protein kinase inhibitors, rho-kinase inhibitors, synthetically produced vasoactive intestinal peptide, antagonists of the 5-HT2 receptors, and others. This article will review several of these promising new therapies and will discuss the current evidence regarding their potential benefit in pulmonary arterial hypertension.
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Affiliation(s)
- Ronald Zolty
- Cardiovascular Divisions, 982265 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198, United States of America.
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Raina R, Chauvin A, Chakraborty R, Nair N, Shah H, Krishnappa V, Kusumi K. The Role of Endothelin and Endothelin Antagonists in Chronic Kidney Disease. KIDNEY DISEASES 2019; 6:22-34. [PMID: 32021871 DOI: 10.1159/000504623] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/30/2019] [Indexed: 12/21/2022]
Abstract
Background Endothelins (ET) are a family of peptides that act as potent vasoconstrictors and pro-fibrotic growth factors. ET-1 is integral to renal and cardiovascular pathophysiology and exerts effects via autocrine, paracrine and endocrine signaling pathways tied to regulation of aldosterone, catecholamines, and angiotensin. In the kidney, ET-1 is critical to maintaining renal perfusion and controls glomerular arteriole tone and hemodynamics. It is hypothesized that ET-1 influences the progression of chronic kidney disease (CKD), and the objective of this review is to discuss the pathophysiology, and role of ET and endothelin receptor antagonists (ERAs) in CKD. Summary The use of ERAs in hypertensive nephropathy has the potential to decrease proteinuria, and in diabetic nephropathy has the potential to restore glycocalyx thickness, also decreasing proteinuria. Focal segmental glomerular sclerosis has no specific Food and Drug Administration-approved therapy currently, however, ERAs show promise in decreasing proteinuria and slowing tissue damage. ET-1 is a potential biomarker for autosomal dominant polycystic kidney disease progression and so it is thought that ERAs may be of some therapeutic benefit. Key Messages Multiple studies have shown the utility of ERAs in CKD. These agents have shown to reduce blood pressure, proteinuria, and arterial stiffness. However, more clinical trials are needed, and the results of active or recently concluded studies are eagerly awaited.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA.,Akron Children's Hospital, Akron, Ohio, USA
| | | | - Ronith Chakraborty
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA
| | - Nikhil Nair
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Haikoo Shah
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Vinod Krishnappa
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA.,Northeast Ohio Medical University, Rootstown, Ohio, USA
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Abstract
Discovered in 1987 as a potent endothelial cell-derived vasoconstrictor peptide, endothelin-1 (ET-1), the predominant member of the endothelin peptide family, is now recognized as a multifunctional peptide with cytokine-like activity contributing to almost all aspects of physiology and cell function. More than 30 000 scientific articles on endothelin were published over the past 3 decades, leading to the development and subsequent regulatory approval of a new class of therapeutics-the endothelin receptor antagonists (ERAs). This article reviews the history of the discovery of endothelin and its role in genetics, physiology, and disease. Here, we summarize the main clinical trials using ERAs and discuss the role of endothelin in cardiovascular diseases such as arterial hypertension, preecclampsia, coronary atherosclerosis, myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) caused by spontaneous coronary artery dissection (SCAD), Takotsubo syndrome, and heart failure. We also discuss how endothelins contributes to diabetic kidney disease and focal segmental glomerulosclerosis, pulmonary arterial hypertension, as well as cancer, immune disorders, and allograft rejection (which all involve ETA autoantibodies), and neurological diseases. The application of ERAs, dual endothelin receptor/angiotensin receptor antagonists (DARAs), selective ETB agonists, novel biologics such as receptor-targeting antibodies, or immunization against ETA receptors holds the potential to slow the progression or even reverse chronic noncommunicable diseases. Future clinical studies will show whether targeting endothelin receptors can prevent or reduce disability from disease and improve clinical outcome, quality of life, and survival in patients.
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Affiliation(s)
- Matthias Barton
- From Molecular Internal Medicine, University of Zürich, Switzerland (M.B.)
- Andreas Grüntzig Foundation, Zürich, Switzerland (M.B.)
| | - Masashi Yanagisawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS) and Life Science Center, Tsukuba Advanced Research Alliance, University of Tsukuba, Japan (M.Y.)
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX (M.Y.)
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Perrin S, Chaumais MC, O'Connell C, Amar D, Savale L, Jaïs X, Montani D, Humbert M, Simonneau G, Sitbon O. New pharmacotherapy options for pulmonary arterial hypertension. Expert Opin Pharmacother 2015; 16:2113-31. [PMID: 26290279 DOI: 10.1517/14656566.2015.1074177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Epoprostenol was the first targeted therapy available for the treatment of pulmonary arterial hypertension (PAH). Since then great advances in our knowledge of the disease have been made and the spectrum of therapeutic options for PAH has expanded. After an overview of current available treatments, this article describes the new pharmacotherapy options and their place in the management of PAH. AREAS COVERED This paper is based on a literature search and the review of studies published on PAH pharmacotherapy using the MEDLINE database. EXPERT OPINION The last decade has been particularly important in PAH management with the emergence of six new molecules, the development of novel routes of administration and improvement of pharmacokinetics. Moreover, pediatric formulations have been developed. However, further research is required to inform clinicians regarding optimal choices of combination therapies (progressive add-on therapy or upfront combination therapy, selection of associated molecules regarding the patient's profile...), to continue to improve the quality of life of patients with new drugs and to reach the ultimate goal of curing the disease.
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Affiliation(s)
- Swanny Perrin
- a 1 University of Paris-Sud, Faculté de Pharmacie , Chatenay-Malabry, France.,b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France
| | - Marie-Camille Chaumais
- a 1 University of Paris-Sud, Faculté de Pharmacie , Chatenay-Malabry, France.,b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,c 3 APHP, Hôpital Antoine Béclère, Service de Pharmacie , Clamart, France
| | - Caroline O'Connell
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - David Amar
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Laurent Savale
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - David Montani
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Marc Humbert
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Gérald Simonneau
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
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Abstract
Diabetic kidney disease (DKD) remains the most common cause of chronic kidney disease and multiple therapeutic agents, primarily targeted at the renin-angiotensin system, have been assessed. Their only partial effectiveness in slowing down progression to end-stage renal disease, points out an evident need for additional effective therapies. In the context of diabetes, endothelin-1 (ET-1) has been implicated in vasoconstriction, renal injury, mesangial proliferation, glomerulosclerosis, fibrosis and inflammation, largely through activation of its endothelin A (ETA) receptor. Therefore, endothelin receptor antagonists have been proposed as potential drug targets. In experimental models of DKD, endothelin receptor antagonists have been described to improve renal injury and fibrosis, whereas clinical trials in DKD patients have shown an antiproteinuric effect. Currently, its renoprotective effect in a long-time clinical trial is being tested. This review focuses on the localization of endothelin receptors (ETA and ETB) within the kidney, as well as the ET-1 functions through them. In addition, we summarize the therapeutic benefit of endothelin receptor antagonists in experimental and human studies and the adverse effects that have been described.
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Effectiveness of phosphodiesterase-5 inhibitor therapy for portopulmonary hypertension. Can Respir J 2014; 22:42-6. [PMID: 25522305 DOI: 10.1155/2015/810376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Portopulmonary hypertension is associated with significant morbidity and mortality. Phosphodiesterase-5 inhibitor therapy is efficacious in other causes of WHO group I pulmonary arterial hypertension. OBJECTIVE To evaluate the efficacy and safety of phosphodiesterase-5 inhibitor therapy in patients with portopulmonary hypertension. METHODS A single-centre retrospective cohort study that included patients with a diagnosis of portopulmonary hypertension was performed. The primary outcome was change in pulmonary vascular resistance after six months of phosphodiesterase-5 inhibitor therapy. A secondary evaluation investigated the effect on other hemodynamic measurements, 6 min walk distance, functional class, safety outcomes and survival. RESULTS Of 1385 patients screened, 25 patients with portopulmonary hypertension were identified, of whom 20 received a phosphodiesterase-5 inhibitor. After six months, there was a significant decrease in pulmonary vascular resistance (-236 dyn • s • cm(-5) [95% CI -343 dyn • s • cm(-5) to -130 dyn • s • cm(-5)]; P<0.001), mean pulmonary artery pressure (-8.9 mmHg [95% CI -13.7 mmHg to -4.2 mmHg]; P=0.001) and an increase in Fick cardiac output (0.9 L/min [95% CI 0.1 L/min to 1.6 L/min]; P=0.02). There was no change in 6 min walk distance. The proportion of subjects with a WHO functional class III or IV was significantly reduced at six months compared with baseline (18% versus 61%; P=0.002). Safety outcomes did not reveal any adverse events. CONCLUSIONS Phosphodiesterase-5 inhibitor therapy improved hemodynamics and functional class at six months in a cohort of patients with portopulmonary hypertension.
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Naito A, Terada J, Tanabe N, Sugiura T, Sakao S, Kanda T, Yokosuka O, Tatsumi K. Autoimmune hepatitis in a patient with pulmonary arterial hypertension treated with endothelin receptor antagonists. Intern Med 2014; 53:771-5. [PMID: 24694495 DOI: 10.2169/internalmedicine.53.1362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 48-year-old woman was diagnosed with idiopathic pulmonary arterial hypertension (PAH) and administered PAH-specific therapies, including bosentan. Four years after the initiation of treatment with bosentan, liver dysfunction appeared, and ambrisentan was substituted for bosentan. One-and-a half years later, a second episode of liver dysfunction occurred. The pathological findings of a liver biopsy specimen were not definitive, although drug-induced hepatotoxicity caused by ambrisentan was considered. However, the patient's liver dysfunction did not improve even after the discontinuation of ambrisentan. Finally, we diagnosed her with autoimmune hepatitis (AIH). Providing careful observation with a suspicion of AIH is important when treating PAH patients with autoantibodies.
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Affiliation(s)
- Akira Naito
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
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Sitaxsentan-induced acute severe hepatitis treated with glucocorticoid therapy. Can Respir J 2012; 19:e1-2. [PMID: 22332138 DOI: 10.1155/2012/567024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endothelin receptor antagonists are commonly used in the treatment of pulmonary hypertension. Sitaxsentan, a selective endothelin A receptor blocker, induces a mild transaminitis in approximately 3% to 5% of patients, but rarely an acute severe hepatitis. A case involving a 61-year-old female with sitaxsentan-induced acute severe liver failure is presented. Depite withdrawal of therapy, her liver tests failed to improve. After six weeks of monitoring, the patient was administered high-dose corticosteroids, with a good clinical and biochemical response. While endothelin receptor antagonists are postulated to cause hepatitis by inhibition of a bile salt transporter pump, an immune-mediated or idiosyncratic mechanism should be considered.
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D’Alto M. An update on the use of ambrisentan in pulmonary arterial hypertension. Ther Adv Respir Dis 2012; 6:331-343. [DOI: 10.1177/1753465812458014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
The development of effective oral treatments that are capable of modulating the activity of endothelin receptor 1 (ET-1) represents a significant milestone in the field of pulmonary arterial hypertension (PAH). Randomized clinical trials confirm that endothelin receptor antagonist (ERA) treatments confer significant improvements on important clinical endpoints, such as exercise capacity, functional class, quality of life and pulmonary hemodynamics. Moreover, ERAs may prevent or delay clinical worsening and retard disease progression. Ambrisentan is a propanoic acid-based ERA, showing preferential affinity for the type A ET-1 over the type B receptor. It provides another valuable, effective treatment option in PAH. Two large, randomized-placebo controlled trials demonstrated the efficacy of ambrisentan in PAH at improving exercise tolerance as measured by the 6 min walk distance. Additional secondary measures of improvement including time to clinical worsening, survival, functional class, quality of life and hemodynamic variables have been reported in clinical trials. A favorably low incidence of aminotransferase elevation indicating lower hepatic toxicity than other ERAs has been observed. Ambrisentan can be safely administered with warfarin or sildenafil without the need for dose adjustment of either therapy. A once daily oral medication with relatively few side effects is an attractive option, especially as the use of therapies in combination continues to increase. Long-term data and hemodynamic data confirm the benefits can be compared with other ERAs with fewer drug–drug interactions and a better liver safety profile.
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Affiliation(s)
- Michele D’Alto
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Piazzale E. Ruggieri, 80131, Naples, Italy
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Kohan DE, Cleland JG, Rubin LJ, Theodorescu D, Barton M. Clinical trials with endothelin receptor antagonists: what went wrong and where can we improve? Life Sci 2012; 91:528-39. [PMID: 22967485 DOI: 10.1016/j.lfs.2012.07.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/07/2023]
Abstract
In the early 1990s, within three years of cloning of endothelin receptors, orally active endothelin receptor antagonists (ERAs) were tested in humans and the first clinical trial of ERA therapy in humans was published in 1995. ERAs were subsequently tested in clinical trials involving heart failure, pulmonary arterial hypertension, resistant arterial hypertension, stroke/subarachnoid hemorrhage and various forms of cancer. The results of most of these trials - except those for pulmonary arterial hypertension and scleroderma-related digital ulcers - were either negative or neutral. Problems with study design, patient selection, drug toxicity, and drug dosing have been used to explain or excuse failures. Currently, a number of pharmaceutical companies who had developed ERAs as drug candidates have discontinued clinical trials or further drug development. Given the problems with using ERAs in clinical medicine, at the Twelfth International Conference on Endothelin in Cambridge, UK, a panel discussion was held by clinicians actively involved in clinical development of ERA therapy in renal disease, systemic and pulmonary arterial hypertension, heart failure, and cancer. This article provides summaries from the panel discussion as well as personal perspectives of the panelists on how to proceed with further clinical testing of ERAs and guidance for researchers and decision makers in clinical drug development on where future research efforts might best be focused.
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Affiliation(s)
- Donald E Kohan
- Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
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Tofield A. The use of pocket size imaging devices: a position statement by the European Association of Echocardiography. Eur Heart J 2011; 32:385-6. [PMID: 21320907 DOI: 10.1093/eurheartj/ehr001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Callaghan DS, Savale L, Yaïci A, Natali D, Jaïs X, Parent F, Montani D, Humbert M, Simonneau G, Sitbon O. Endothelin receptor antagonists for the treatment of pulmonary arterial hypertension. Expert Opin Pharmacother 2011; 12:1585-96. [PMID: 21504371 DOI: 10.1517/14656566.2011.564159] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Endothelin is a key mediator in the pathophysiology of pulmonary arterial hypertension (PAH). Its effects are mediated through the activation of two associated receptor subtypes, termed A and B. Therapeutic strategies that modulate the activity of endothelin are, therefore, of interest to improve the functional status of patients with PAH. AREAS COVERED The rationale for the use of endothelin receptor antagonists as a therapeutic class in PAH and pertinent data from important clinical studies are presented in this review. Areas for future research are also suggested. EXPERT OPINION The availability of the endothelin receptor antagonist class of agents represents a significant addition to the therapeutic armamentarium which is available for the treatment of PAH. Comparative studies are warranted to establish whether selective endothelin-A receptor antagonism is more advantageous than dual receptor antagonism. Future studies of endothelin receptor antagonists will increasingly focus on the potential of a combination of different PAH therapeutic classes and will employ 'harder' clinical end points. This is of crucial importance to ensure that future developments are both worthwhile and acceptable to patients, physicians, health system payers and regulatory authorities.
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Smith DA, Harrison A, Morgan P. Multiple Factors Govern the Association between Pharmacology and Toxicity in a Class of Drugs: Toward a Unification of Class Effect Terminology. Chem Res Toxicol 2011; 24:463-74. [DOI: 10.1021/tx100408v] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Dennis A. Smith
- Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Sandwich, Kent, CT13 9NJ, United Kingdom
| | - Anthony Harrison
- Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Sandwich, Kent, CT13 9NJ, United Kingdom
| | - Paul Morgan
- Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Sandwich, Kent, CT13 9NJ, United Kingdom
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Dwyer N, Kilpatrick D. Bosentan for the treatment of adult pulmonary hypertension. Future Cardiol 2011; 7:19-37. [DOI: 10.2217/fca.10.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pulmonary hypertension is a severe progressive disease with a marked morbidity and a high mortality attributed to right heart failure. Bosentan, a dual endothelin receptor antagonist, is an effective and well-tolerated oral therapy for the management of pulmonary arterial hypertension (PAH; WHO group 1 pulmonary hypertension). Bosentan improves cardiopulmonary hemodynamics, exercise capacity, WHO functional class and quality of life, as well as delaying time to clinical worsening in patients with PAH. This article reviews the role of endothelin-1 in the pathogenesis and progression of PAH, the diagnosis of PAH and the pharmacology of bosentan, and summarizes the current available evidence for the safety and efficacy of bosentan for the treatment of PAH as a monotherapy and combination therapy, as well as its role in the management of other forms of pulmonary hypertension.
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Affiliation(s)
| | - David Kilpatrick
- Cardiology Department, Royal Hobart Hospital, 48 Liverpool Street, Hobart 7000, Tasmania, Australia
- Discipline of Medicine, University of Tasmania, Hobart, Australia
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Masson MJ, Collins LA, Carpenter LD, Graf ML, Ryan PM, Bourdi M, Pohl LR. Pathologic role of stressed-induced glucocorticoids in drug-induced liver injury in mice. Biochem Biophys Res Commun 2010; 397:453-8. [PMID: 20510877 DOI: 10.1016/j.bbrc.2010.05.126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 05/22/2010] [Indexed: 01/13/2023]
Abstract
UNLABELLED We previously reported that acetaminophen (APAP)-induced liver injury (AILI) in mice is associated with a rise in serum levels of the glucocorticoid (GC), corticosterone. In the current study, we provide evidence that endogenous GC play a pathologic role in AILI. Specifically, pretreatment of mice with the GC receptor (GCR) inhibitor, RU486 (mifepristrone), protected normal but not adrenalectomized mice from AILI, while pretreatment with dexamethasone, a synthetic GC, exacerbated AILI. RU486 did not affect the depletion of whole liver reduced GSH or the formation of APAP-protein adducts. It also had no effects on the formation of reactive oxygen species or the depletion of mitochondrial GSH or ATP. While RU486 pretreatment also protected against halothane-induced liver injury, it exacerbated concanavalin A (ConA)- and carbon tetrachloride (CCl(4))-induced liver injury, demonstrating the complexity of GC effects in different types of liver injury. CONCLUSION These results suggest that under certain conditions, elevated levels of GC might represent a previously unappreciated risk factor for liver injury caused by APAP and other drugs through the diverse biological processes regulated by GCR.
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Affiliation(s)
- Mary Jane Masson
- Molecular and Cellular Toxicology Section, Laboratory of Molecular Immunology, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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