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Mokry J, Urbanova A, Kertys M, Mokra D. Inhibitors of phosphodiesterases in the treatment of cough. Respir Physiol Neurobiol 2018; 257:107-114. [PMID: 29337269 DOI: 10.1016/j.resp.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/28/2017] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Abstract
A group of 11 enzyme families of metalophosphohydrolases called phosphodiesterases (PDEs) is responsible for a hydrolysis of intracellular cAMP and cGMP. Xanthine derivatives (methylxanthines) inhibit PDEs without selective action on their single isoforms and lead to many pharmacological effects, e.g. bronchodilation, anti-inflammatory and immunomodulating effects, and thus they can modulate the cough reflex. Contrary, selective PDE inhibitors have been developed to inhibit PDE isoforms with different pharmacological effects based on their tissue expression. In this paper, effects of non-selective PDE inhibitors (e.g. theophylline) are discussed, with a description of other putative mechanisms in their effects on cough. Antitussive effects of selective inhibitors of several PDE isoforms are reviewed, focusing on PDE1, PDE3, PDE4, PDE5 and PDE7. The inhibition of PDEs suggests participation of bronchodilation, suppression of TRPV channels and anti-inflammatory action in cough suppression. Selective PDE3, PDE4 and PDE5 inhibitors have demonstrated the most significant cough suppressive effects, confirming their benefits in chronic inflammatory airway diseases associated with bronchoconstriction and cough.
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Affiliation(s)
- Juraj Mokry
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
| | - Anna Urbanova
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Martin Kertys
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Daniela Mokra
- Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Dicpinigaitis PV, Morice AH, Birring SS, McGarvey L, Smith JA, Canning BJ, Page CP. Antitussive drugs--past, present, and future. Pharmacol Rev 2014; 66:468-512. [PMID: 24671376 PMCID: PMC11060423 DOI: 10.1124/pr.111.005116] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Cough remains a serious unmet clinical problem, both as a symptom of a range of other conditions such as asthma, chronic obstructive pulmonary disease, gastroesophageal reflux, and as a problem in its own right in patients with chronic cough of unknown origin. This article reviews our current understanding of the pathogenesis of cough and the hypertussive state characterizing a number of diseases as well as reviewing the evidence for the different classes of antitussive drug currently in clinical use. For completeness, the review also discusses a number of major drug classes often clinically used to treat cough but that are not generally classified as antitussive drugs. We also reviewed a number of drug classes in various stages of development as antitussive drugs. Perhaps surprising for drugs used to treat such a common symptom, there is a paucity of well-controlled clinical studies documenting evidence for the use of many of the drug classes in use today, particularly those available over the counter. Nonetheless, there has been a considerable increase in our understanding of the cough reflex over the last decade that has led to a number of promising new targets for antitussive drugs being identified and thus giving some hope of new drugs being available in the not too distant future for the treatment of this often debilitating symptom.
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Affiliation(s)
- P V Dicpinigaitis
- King's College London, Franklin Wilkins Building, 100 Stamford St., London, SE1 9NH, UK.
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Banner KH, Press NJ. Dual PDE3/4 inhibitors as therapeutic agents for chronic obstructive pulmonary disease. Br J Pharmacol 2009; 157:892-906. [PMID: 19508401 DOI: 10.1111/j.1476-5381.2009.00170.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Phosphodiesterase (PDE)4, and to a lesser extent, PDE3/4 inhibitors have attracted considerable interest as potential therapeutic agents for diseases including chronic obstructive pulmonary disease. Indeed, ibudilast and theophylline are utilized clinically, and roflumilast is in late-stage clinical development. Unfortunately, however many PDE4 and dual PDE3/4 inhibitors have failed in early development due to low therapeutic ratios. The majority of these compounds are however orally administered and non-selective for either PDE3(A, B) or PDE4(A, B, C, D) subtypes. Developing an inhaled dual PDE3/4 inhibitor with subtype specificity may represent one strategy to improve the therapeutic index. Indeed combined inhibition of PDE3 and PDE4 inhibitor has additive and synergistic anti-inflammatory and bronchodilatory effects versus inhibition of either PDE3 or PDE4 alone. Given that synergy has been seen in terms of efficacy end points, an obvious concern is that synergy may also be observed in side effects. Interestingly, however, no synergy or additive effects with a combination of a PDE3 and PDE4 inhibitor in a cardiomyocyte assay were observed. This review will summarize the rationale for developing an inhaled dual PDE3/4 inhibitor, as a treatment for chronic obstructive pulmonary disease together with recent advances in trying to understand the pathogenesis of PDE inhibitor-induced mesenteric vasculitis (a key potential dose-limiting side effect of these agents), highlighting potential early and sensitive predictive biomarkers.
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Affiliation(s)
- Katharine H Banner
- Novartis Institute for Biomedical Research, Horsham, West Sussex, RH12 5AB, UK.
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Tintinger GR, Steel HC, Theron AJ, Anderson R. Pharmacological control of neutrophil-mediated inflammation: strategies targeting calcium handling by activated polymorphonuclear leukocytes. Drug Des Devel Ther 2009; 2:95-104. [PMID: 19920897 PMCID: PMC2761182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Unlike most other effector cells of the innate, as well as the adaptive immune systems, the neutrophil is a relatively undiscerning aggressor with scant regard for damage limitation. Although this highly combative, professional phagocyte has become increasingly implicated in the immunopathogenesis of many acute and chronic inflammatory disorders, of both infective and noninfective origin, effective pharmacological strategies to counter neutrophil aggression have remained elusive. Activation of neutrophils results in rapid mobilization of both stored and extracellular Ca(2+), resulting in abrupt, usually transient increases in cytosolic Ca(2+), which precede, and are a prerequisite for activation of the Ca(2+)-dependent pro-inflammatory activities of these cells. Mobilization of Ca(2+) by, and restoration of Ca(2+) homeostasis to activated neutrophils are multistep processes which present a number of potential targets, some well recognized and others novel and unconventional, for the pharmacological control of neutrophil-mediated inflammation. Uncovering these targets represents the primary focus of this review.
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Affiliation(s)
- Gregory R Tintinger
- Correspondence: Gregory R Tintinger, Department of Immunology, PO Box 2034, Pretoria 0001, South Africa, Tel + 27 12 354 6883, Fax + 27 12 323 0732, Email
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Antoniu SA, Mihaescu T, Donner CF. Pharmacotherapy of cough-variant asthma. Expert Opin Pharmacother 2007; 8:3021-8. [PMID: 18001260 DOI: 10.1517/14656566.8.17.3021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cough-variant asthma is considered as an asthma subset in which chronic cough is the only symptom. It is believed to be more frequent and, hence, sometimes overdiagnosed in children, and shares with typical asthma eosinophilic airway inflammation and consequent bronchial hyper-responsiveness. Presently available therapies consist of bronchodilators, inhaled or oral corticosteroids, or leukotriene modifiers. However, the long-term efficacy of these agents in adults and children is not known. This review focuses on current therapies used for cough variant asthma, also highlighting potential therapeutic targets for this condition.
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Affiliation(s)
- Sabina A Antoniu
- University of Medicine and Pharmacy, Gr.T.Popa Iasi, Pulmonary Disease Division, 30 Dr I Cihac Str, 700115 Iasi, Romania.
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Groneberg-Kloft B, Feleszko W, Dinh QT, van Mark A, Brinkmann E, Pleimes D, Fischer A. Analysis and evaluation of environmental tobacco smoke exposure as a risk factor for chronic cough. COUGH 2007; 3:6. [PMID: 17475014 PMCID: PMC1884172 DOI: 10.1186/1745-9974-3-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 05/02/2007] [Indexed: 11/11/2022]
Abstract
Exposure to environmental tobacco smoke (ETS) and active tobacco smoking has been shown to increase symptoms of bronchial asthma such as bronchoconstriction but effects on other respiratory symptoms remain poorly assessed. Current levels of exposure to tobacco smoke may also be responsible for the development of chronic cough in both children and adults. The present study analyses the effects of tobacco smoke exposure as potential causes of chronic cough. A panel of PubMed-based searches was performed relating the symptom of cough to various forms of tobacco smoke exposure. It was found that especially prenatal and postnatal exposures to ETS have an important influence on children's respiratory health including the symptom of cough. These effects may be prevented if children and pregnant women are protected from exposure to ETS. Whereas the total number of studies adressing the relationship between cough and ETS exposure is relatively small, the present study demonstrated that there is a critical amout of data pointing to a causative role of environmental ETS exposure for the respiratory symptom of cough. Since research efforts have only targeted this effect to a minor extent, future epidemiological and experimental studies are needed to further unravel the relation between ETS and cough.
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Affiliation(s)
- Beatrix Groneberg-Kloft
- Division of Allergy Research, Charité – Universitätsmedizin Berlin, Free University and Humboldt-University, D-13353 Berlin, Germany
| | - Wojciech Feleszko
- Department of Pediatric Pneumology and Allergy, The Medical University Children's Hospital, PL-01-184 Warsaw, Poland
| | - Quoc Thai Dinh
- Department of Medicine, Charité – Universitätsmedizin Berlin, Free University and Humboldt-University, D-13353 Berlin, Germany
| | - Anke van Mark
- Institute of Occupational Medicine, University zu Lübeck, D-23538 Lübeck, Germany
| | - Elke Brinkmann
- Department of Prevention, Norddeutsche Metall-Berufsgenossenschaft, D-30173 Hannover, Germany
| | - Dirk Pleimes
- Division of Allergy Research, Charité – Universitätsmedizin Berlin, Free University and Humboldt-University, D-13353 Berlin, Germany
| | - Axel Fischer
- Division of Allergy Research, Charité – Universitätsmedizin Berlin, Free University and Humboldt-University, D-13353 Berlin, Germany
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Abstract
PURPOSE OF REVIEW The intention of this article is to discuss and place into perspective recent articles on cough and asthma. RECENT FINDINGS Asthma continues to be a major diagnosis in most studies of cough. The first prospective study of sub-acute cough demonstrated an asthma incidence lower than that for chronic cough, a logical finding; upper airway cough syndrome often causes cough in the postinfectious state. The first prospective study of cough in infants suggested asthma to be a minor cause of cough in infants, but methodological flaws make the conclusions uncertain. Efforts to separate cough-variant asthma from classic asthma continue. One group has demonstrated that the maximal bronchoconstrictor response in cough-variant asthma is blunted when compared with classic asthma, a possible explanation for the absence of wheeze and dyspnea in cough-variant asthma. Another look at airway resistance showed a less rapid rate of rise in resistance in cough-variant asthma with increasing methacholine dosing than in classic asthma. On the biochemical front, a group has demonstrated differences in vascular endothelial growth factor, which may be the underpinnings of differences between cough-variant asthma and classic asthma. SUMMARY Recent data suggest that cough-variant asthma is part of a continuum in the expression of asthma symptoms and in the asthmatic inflammatory response.
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Affiliation(s)
- Wissam Abouzgheib
- Division of Pulmonary and Critical Care Medicine, Cooper University Hospital, Camden, New Jersey, USA
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Wagner U, Staats P, Fehmann HC, Fischer A, Welte T, Groneberg DA. Analysis of airway secretions in a model of sulfur dioxide induced chronic obstructive pulmonary disease (COPD). J Occup Med Toxicol 2006; 1:12. [PMID: 16759388 PMCID: PMC1559628 DOI: 10.1186/1745-6673-1-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 06/07/2006] [Indexed: 01/08/2023] Open
Abstract
Hypersecretion and chronic phlegm are major symptoms of chronic obstructive pulmonary disease (COPD) but animal models of COPD with a defined functional hypersecretion have not been established so far. To identify an animal model of combined morphological signs of airway inflammation and functional hypersecretion, rats were continuously exposed to different levels of sulfur dioxide (SO2, 5 ppm, 10 ppm, 20 ppm, 40 ppm, 80 ppm) for 3 (short-term) or 20–25 (long-term) days. Histology revealed a dose-dependent increase in edema formation and inflammatory cell infiltration in short-term-exposed animals. The submucosal edema was replaced by fibrosis after long-term-exposure. The basal secretory activity was only significantly increased in the 20 ppm group. Also, stimulated secretion was significantly increased only after exposure to 20 ppm. BrdU-assays and AgNOR-analysis demonstrated cellular metaplasia and glandular hypertrophy rather than hyperplasia as the underlying morphological correlate of the hypersecretion. In summary, SO2-exposure can lead to characteristic airway remodeling and changes in mucus secretion in rats. As only long-term exposure to 20 ppm leads to a combination of hypersecretion and airway inflammation, only this mode of exposure should be used to mimic human COPD. Concentrations less or higher than 20 ppm or short term exposure do not induce the respiratory symptom of hypersecretion. The present model may be used to characterize the effects of new compounds on mucus secretion in the background of experimental COPD.
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Affiliation(s)
- Ulrich Wagner
- Department of Medicine, Pulmonary and Critical Care Division, Philipps-University, Baldingerstr., D-35043 Marburg, Germany
- Department of Medicine/Respiratory Medicine, Klinik Löwenstein, Geißhölzle 62, D-74245 Löwenstein, Germany
| | - Petra Staats
- Department of Medicine, Pulmonary and Critical Care Division, Philipps-University, Baldingerstr., D-35043 Marburg, Germany
| | - Hans-Christoph Fehmann
- Department of Medicine, Pulmonary and Critical Care Division, Philipps-University, Baldingerstr., D-35043 Marburg, Germany
| | - Axel Fischer
- Allergy-Centre-Charité, Otto-Heubner-Centre, Pneumology and Immunology, Charité – Universitätsmedizin Berlin, Free and Humboldt-University Berlin, Augustenburger Platz 1 OR-1, D-13353 Berlin, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1 OE 6870, D-30625 Hannover, Germany
| | - David A Groneberg
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1 OE 6870, D-30625 Hannover, Germany
- Institute of Occupational Medicine, Charité – Universitätsmedizin Berlin, Free and Humboldt-University Berlin, Ostpreussendamm 111, D-12207 Berlin, Germany
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