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Abbasi B, Shaw NM, Lui JL, Hakam N, Nabavizadeh B, Breyer BN. Oral phosphodiesterase type 5 inhibitors and priapism: A VigiBase analysis. Pharmacoepidemiol Drug Saf 2024; 33:e5721. [PMID: 37909414 DOI: 10.1002/pds.5721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To explore the differences of priapism events among a diverse cohort taking erectogenic medicines (i.e., phosphodiesterase type 5 inhibitors [PDE5i] and intracavernousal drugs). METHODS We queried the World Health Organization global database of individual case safety reports (VigiBase) for records of the adverse drug reactions (ADR) with sildenafil, tadalafil, avanafil, vardenafil, papaverine, and alprostadil. Disproportionality analyses (case/non-case approach) were performed to assess the reporting odds ratio (ROR) of priapism reporting in PDE5i consumers compared to intracavernousal drug recipients. RESULTS From a total of 133 819 ADR events for erectogenic medications, 632 were priapism (PDE5is: n = 550, 0.41%; intracavernousal drugs: n = 82, 9.92%). Priapism disproportionality signals from intracavernousal drugs were 25 times stronger than PDE5is (ROR = 34.7; confidence interval [CI] 95%: 27.12-43.94 vs. ROR = 1.38; 95% CI: 1.24-1.54). For all PDE5i agents, the 12-17 years age group had the highest ROR (9.49, 95% CI: 3.76-19.93) followed by 2-11 years (4.31, 95% CI: 1.57-9.4). Disproportionality signals for consumers under 18 for both all PDE5is as a whole (ROR = 4.57, 95% CI: 2.48-7.73) and sildenafil (ROR = 4.89, 95% CI: 2.51-8.62) were stronger than individuals 18 or older (ROR = 1.06, 95% CI: 0.93-1.21 and ROR = 1.08, 95% CI: 0.91-1.26, respectively). CONCLUSIONS PDE5i use shows disproportionate priapism signals which are higher in young patients.
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Affiliation(s)
- Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jason L Lui
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Nelson EJ, Cook E, Nelson S, Brown R, Pierce M, Seelos AB, Stickle H, Johansen M. Quantifying side effects and caregiver burdens of pediatric pulmonary hypertension therapies. BMC Pediatr 2023; 23:43. [PMID: 36698086 PMCID: PMC9875396 DOI: 10.1186/s12887-023-03860-2] [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: 09/15/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary hypertension (PH) is a rare, but serious disease among children. However, PH has been primarily evaluated among adults. Consequently, treatment therapies have not been fully evaluated among pediatric populations and are used in an 'off label' manner. The purpose of this study was to estimate the side effect profiles of the most commonly prescribed pediatric PH therapies and to understand the burdens placed upon families caring for children living with PH. METHODS Participants were recruited online through the "Families of children with pulmonary hypertension" Facebook group and asked to complete a survey about PH treatments. RESULTS A total of 139 parents of a child living with PH completed the survey. Almost all children used ≥ 1 medication to treat PH, with 52% using ≥ 3 medications. The highest average number of side effects was reported by users of Treprostinil, Selexipag and type-5 phosphodiesterase (PDE5) inhibitors. The most common side effects were skin flushing, headache, nasal congestion, joint/muscle pain, and nausea. In terms of accessing care, 81% travel ≥ 20 miles and 68% travel for ≥ 60 min to receive care. CONCLUSIONS We found an array of treatment combinations employed to mitigate symptoms of PH in children, with a wide range of side effects. We also found a large, unseen economic, emotional, and time burden of caring for a child living with PH. Further research is warranted to understand the clinical implications of these side effects to move towards labeled usage of these therapies rather than post-hoc off-label usage.
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Affiliation(s)
- Erik J. Nelson
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Ella Cook
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Samara Nelson
- grid.53857.3c0000 0001 2185 8768Emma Eccles Jones College of Education & Human Services, Utah State University, Logan, UT USA
| | - Rebecca Brown
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Megan Pierce
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Ashley Bangerter Seelos
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Heather Stickle
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Michael Johansen
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, IN USA
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Falcão MC, Telles APA, Aguiar MLMD, Bigio JZD. Use of sildenafil in late postoperative period of congenital diaphragmatic hernia. J Bras Pneumol 2021; 47:e20210143. [PMID: 34495177 PMCID: PMC8979671 DOI: 10.36416/1806-3756/e20210143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mário Cícero Falcão
- . Departamento de Pediatria, Instituto da Criança - ICr - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ana Paula Andrade Telles
- . Departamento de Pediatria, Instituto da Criança - ICr - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Marcela Ludwig Macedo da Aguiar
- . Departamento de Pediatria, Instituto da Criança - ICr - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Juliana Zoboli Del Bigio
- . Departamento de Pediatria, Instituto da Criança - ICr - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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4
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Troiano G, Lazzeri G. The potential toxic combination of grapefruit juice and sildenafil. TOXIN REV 2021. [DOI: 10.1080/15569543.2019.1603163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gianmarco Troiano
- University of Siena, Department of Molecular and Developmental Medicine, Siena, Italy
| | - Giacomo Lazzeri
- University of Siena, Department of Molecular and Developmental Medicine, Siena, Italy
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Luo F, Wu L, Xie G, Gao F, Zhang Z, Chen G, Liu Z, Zha L, Zhang G, Sun Y, Zhang Z, Wang Y. Dual-Functional MN-08 Attenuated Pulmonary Arterial Hypertension Through Vasodilation and Inhibition of Pulmonary Arterial Remodeling. Hypertension 2021; 77:1787-1798. [PMID: 33775126 DOI: 10.1161/hypertensionaha.120.15994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Fangcheng Luo
- From the Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University and Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (F.L., L.W.)
| | - Liangmiao Wu
- From the Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University and Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (F.L., L.W.)
| | - Guoqing Xie
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - FangFang Gao
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Zhixiang Zhang
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Guangying Chen
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Zheng Liu
- School of Stomatology and Medicine, Foshan University, P. R. China (Z.L.)
| | - Ling Zha
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Gaoxiao Zhang
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Yewei Sun
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Zaijun Zhang
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
| | - Yuqiang Wang
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, China (G.X., F.G., Zhixiang Zhang, G.C., L.Z., G.Z., Y.S., Zaijun Zhang, Y.W.)
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Geva A, Stedman JP, Manzi SF, Lin C, Savova GK, Avillach P, Mandl KD. Adverse drug event presentation and tracking (ADEPT): semiautomated, high throughput pharmacovigilance using real-world data. JAMIA Open 2020; 3:413-421. [PMID: 33215076 PMCID: PMC7660953 DOI: 10.1093/jamiaopen/ooaa031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To advance use of real-world data (RWD) for pharmacovigilance, we sought to integrate a high-sensitivity natural language processing (NLP) pipeline for detecting potential adverse drug events (ADEs) with easily interpretable output for high-efficiency human review and adjudication of true ADEs. Materials and methods The adverse drug event presentation and tracking (ADEPT) system employs an open source NLP pipeline to identify in clinical notes mentions of medications and signs and symptoms potentially indicative of ADEs. ADEPT presents the output to human reviewers by highlighting these drug-event pairs within the context of the clinical note. To measure incidence of seizures associated with sildenafil, we applied ADEPT to 149 029 notes for 982 patients with pediatric pulmonary hypertension. Results Of 416 patients identified as taking sildenafil, NLP found 72 [17%, 95% confidence interval (CI) 14–21] with seizures as a potential ADE. Upon human review and adjudication, only 4 (0.96%, 95% CI 0.37–2.4) patients with seizures were determined to have true ADEs. Reviewers using ADEPT required a median of 89 s (interquartile range 57–142 s) per patient to review potential ADEs. Discussion ADEPT combines high throughput NLP to increase sensitivity of ADE detection and human review, to increase specificity by differentiating true ADEs from signs and symptoms related to comorbidities, effects of other medications, or other confounders. Conclusion ADEPT is a promising tool for creating gold standard, patient-level labels for advancing NLP-based pharmacovigilance. ADEPT is a potentially time savings platform for computer-assisted pharmacovigilance based on RWD.
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Affiliation(s)
- Alon Geva
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Stedman
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shannon F Manzi
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Clinical Pharmacogenomics Service, Division of Genetics & Genomics and Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Chen Lin
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Guergana K Savova
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Avillach
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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7
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Nees SN, Rosenzweig EB, Cohen JL, Valencia Villeda GA, Krishnan US. Targeted Therapy for Pulmonary Hypertension in Premature Infants. CHILDREN-BASEL 2020; 7:children7080097. [PMID: 32824244 PMCID: PMC7464771 DOI: 10.3390/children7080097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Pulmonary hypertension (PH) is common in premature infants with bronchopulmonary dysplasia (BPD) and is associated with significant mortality. Despite expert consensus suggesting the use of targeted therapies such as phosphodiesterase inhibitors, endothelin receptor antagonists, and prostanoids, there is little data on safety and outcomes in infants with BPD-associated PH (BPD-PH) treated with these medications. We sought to describe the pharmacologic management of BPD-PH and to report outcomes at our institution. Premature infants with BPD-PH born between 2005 and 2016 were included. Follow-up data were obtained through January 2020. A total of 101 patients (61 male, 40 female) were included. Of these, 99 (98.0%) patients were treated with sildenafil, 13 (12.9%) with bosentan, 35 (34.7%) with inhaled iloprost, 12 (11.9%) with intravenous epoprostenol, and nine (8.9%) with subcutaneous treprostinil. A total of 33 (32.7%) patients died during the study period and 10 (9.9%) were secondary to severe to pulmonary hypertension. Of the surviving patients, 57 (83.8%) had follow-up data at a median of 5.1 (range 0.38-12.65) years and 44 (77.2%) were weaned off PH medications at a median 2.0 (range 0-8) years. Mortality for BPD-PH remains high mostly due to co-morbid conditions. However, for those patients that survive to discharge, PH therapies can frequently be discontinued in the first few years of life.
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Affiliation(s)
- Shannon N. Nees
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (S.N.N.); (E.B.R.)
| | - Erika B. Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (S.N.N.); (E.B.R.)
| | - Jennifer L. Cohen
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY 10029, USA;
| | | | - Usha S. Krishnan
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (S.N.N.); (E.B.R.)
- Correspondence:
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Nydegger C, Corno AF, von Segesser LK, Beghetti M, Samaja M, Milano G. Effects of PDE-5 Inhibition on the Cardiopulmonary System After 2 or 4 Weeks of Chronic Hypoxia. Cardiovasc Drugs Ther 2020; 33:407-414. [PMID: 31264002 PMCID: PMC6689028 DOI: 10.1007/s10557-019-06887-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose In pulmonary hypertension (PH), hypoxia represents both an outcome and a cause of exacerbation. We addressed the question whether hypoxia adaptation might affect the mechanisms underlying PH alleviation through phosphodiesterase-5 (PDE5) inhibition. Methods Eight-week-old male Sprague-Dawley rats were divided into two groups depending on treatment (placebo or sildenafil, a drug inhibiting PDE5) and were exposed to hypoxia (10% O2) for 0 (t0, n = 9/10), 2 (t2, n = 5/5) or 4 (t4, n = 5/5) weeks. The rats were treated (0.3 mL i.p.) with either saline or sildenafil (1.4 mg/Kg per day). Results Two-week hypoxia changed the body weight (− 31% vs. − 27%, respectively, P = NS), blood hemoglobin (+ 25% vs. + 27%, P = NS) and nitrates+nitrites (+ 175% vs. + 261%, P = 0.007), right ventricle fibrosis (+ 814% vs. + 317%, P < 0.0001), right ventricle hypertrophy (+ 84% vs. + 49%, P = 0.007) and systolic pressure (+ 108% vs. + 41%, P = 0.001), pulmonary vessel density (+ 61% vs. + 46%, P = NS), and the frequency of small (< 50 µm wall thickness) vessels (+ 35% vs. + 13%, P = 0.0001). Most of these changes were maintained for 4-week hypoxia, except blood hemoglobin and right ventricle hypertrophy that continued increasing (+ 52% vs. + 42%, P = NS; and + 104% vs. + 83%, P = 0.04). To further assess these observations, small vessel frequency was found to be linearly related with the right ventricle-developed pressure independent of hypoxia duration. Conclusions Thus, although hypoxia adaptation is not yet accomplished after 4 weeks, PH alleviation by PDE5 inhibition might nevertheless provide an efficient strategy for the management of this disease.
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Affiliation(s)
- Coline Nydegger
- Department Cœur-Vaisseaux, Cardiac Surgery center, University Hospital of Lausanne, Lausanne, Switzerland
| | - Antonio F Corno
- Cardiovascular Research Center, University of Leicester, Leicester, UK
| | - Ludwig K von Segesser
- Cardiovascular Research Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, University of Geneva, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Children's University Hospitals, Geneva and Lausanne, Lausanne, Switzerland
| | - Michele Samaja
- Department of Health Science, University of Milan, Milan, Italy
| | - Giuseppina Milano
- Department Cœur-Vaisseaux, Cardiac Surgery center, University Hospital of Lausanne, Lausanne, Switzerland.
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Abstract
BACKGROUND Enteral sildenafil may be used in the intensive care unit for treatment of pulmonary arterial hypertension. We aimed to determine if initial enteral sildenafil dosing is safe in children receiving concurrent vasoactive infusions. METHODS We performed a single-centre retrospective chart review that included patients less than 2 years of age in paediatric and cardiovascular intensive care units at an academic medical centre from 1 January, 2010 to 30 November, 2016. Included patients received concomitant enteral sildenafil and a continuously infused vasoactive agent. Exclusion criteria consisted of mechanical circulatory support, any form of dialysis, or a suspicion of septic shock at the time of sildenafil initiation. We sought to identify patients who developed worsening hemodynamic instability after initiation of enteral sildenafil defined as one or more of the following observations within 24 hours of sildenafil initiation: sildenafil discontinuation, total fluid bolus receipt >10 ml/kg, increased vasoactive support, epinephrine intravenous push administration, and/or the initiation of mechanical circulatory support. RESULTS Worsening hemodynamic instability was identified in 35% of the 130-patient cohort. Patients younger than 4 months were at increased risk of further hemodynamic instability compared with older patients (56% versus 44%, p = 0.0003) despite receiving lower median doses (1.28 mg/kg/day versus 1.78 mg/kg/day, p = 0.01). CONCLUSIONS Critically ill children receiving vasoactive infusions may be at increased risk for further hemodynamic instability after initiation of enteral sildenafil, particularly in younger patients. This population may benefit from lower starting enteral sildenafil doses of 0.25 mg/kg/dose or less every 8 hours to avoid further hemodynamic compromise.
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10
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Efficacy and safety of a novel nitric oxide generator for the treatment of neonatal pulmonary hypertension: Experimental and clinical studies. Pulm Pharmacol Ther 2018; 54:68-76. [PMID: 30529287 DOI: 10.1016/j.pupt.2018.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a complex pathology resulting from a failure of the post-natal reduction in pulmonary vascular resistance leading to hypoxemia. The standard therapy is inhaled Nitric Oxide (NO) improving oxygenation but its availability is limited, especially in hospitals with restricted financial resources. We evaluated the efficacy and safety of a new device generating NO (TAS + PLUS), in three experimental piglet models of pulmonary hypertension (PH), and we later tested its application in a pilot study of newborn patients suffering from PPHN. Piglets with experimentally induced PH showed a decrease in pulmonary arterial pressure (PAP) after breathing NO. Both acute and chronic exposure of piglets and rats did not cause any adverse effect in blood gas levels and biological parameters. A pilot study including 32 patients suffering from PPHN showed an increase in oxygen saturation (SatO2) and partial pressure of oxygen in arterial blood (PaO2) leading to a decrease of Oxygenation Index (OI) after compassionate treatment with NO from TAS + PLUS device. The device showed effectiveness and safety both in experimental PH and in the clinical setting. Therefore, it represents an excellent alternative for PPHN management in conditions where commercial NO is unavailable.
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Tan R, Lee YJ, Cho KW, Kang DG, Lee HS. Beneficial Effect of Berberis amurensis Rupr. on Penile Erection. Chin J Integr Med 2018; 24:448-454. [PMID: 29335865 DOI: 10.1007/s11655-017-2920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether the methanol extract of Berberis amurensis Rupr. (BAR) augments penile erection using in vitro and in vivo experiments. METHODS The ex vivo study used corpus cavernosum strips prepared from adult male New Zealand White rabbits. In in vivo studies for intracavernous pressure (ICP), blood pressure, mean arterial pressure (MAP), and increase of peak ICP were continuously monitored during electrical stimulation of Sprague-Dawley rats. RESULTS Preconstricted with phenylephrine (PE) in isolated endotheliumintact rabbit corus cavernosum, BAR relaxed penile smooth muscle in a dose-dependent manner, which was inhibited by pretreatment with NG-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, and 1H-[1,2,4]-oxadiazole-[4,3-α]-quinoxalin-1-one, a soluble guanylyl cclase inhibitor. BAR significantly relaxed penile smooth muscles dose-dependently in ex vivo, and this was inhibited by pretreatment with L-NAME 1H-[1,2,4]-oxadiazole-[4,3-α]-quinoxalin-1-one. BAR-induced relaxation was significantly attenuated by pretreatment with tetraethylammonium (TEA, P<0.01), a nonselective K+ channel blocker, 4-aminopyridine (4-AP, P<0.01), a voltage-dependent K+ channel blocker, and charybdotoxin (P<0.01), a large and intermediate conductance Ca2+ sensitive-K+ channel blocker, respectively. BAR induced an increase in peak ICP, ICP/MAP ratio and area under the curve dose dependently. CONCLUSION BAR augments penile erection via the nitric oxide/cyclic guanosine monophosphate system and Ca2+ sensitive-K+ (BKCa and IKCa) channels in the corpus cavernosum.
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Affiliation(s)
- Rui Tan
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk, 570-749, Republic of Korea
| | - Yun Jung Lee
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk, 570-749, Republic of Korea
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Shinyong-dong, Iksan, Jeonbuk, 570-749, Republic of Korea
| | - Kyung Woo Cho
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Shinyong-dong, Iksan, Jeonbuk, 570-749, Republic of Korea
| | - Dae Gill Kang
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk, 570-749, Republic of Korea
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Shinyong-dong, Iksan, Jeonbuk, 570-749, Republic of Korea
- Brain Korea 21 Plus Team, Professional Graduate School of Oriental Medicine, Wonkwang University, Shinyong-dong, Iksan, Jeonbuk, 570-749, Republic of Korea
| | - Ho Sub Lee
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk, 570-749, Republic of Korea.
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Shinyong-dong, Iksan, Jeonbuk, 570-749, Republic of Korea.
- Brain Korea 21 Plus Team, Professional Graduate School of Oriental Medicine, Wonkwang University, Shinyong-dong, Iksan, Jeonbuk, 570-749, Republic of Korea.
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Abstract
Pulmonary hypertension in the perinatal period can present acutely (persistent pulmonary hypertension of the newborn) or chronically. Clinical and echocardiographic diagnosis of acute pulmonary hypertension is well accepted but there are no broadly validated criteria for echocardiographic diagnosis of pulmonary hypertension later in the clinical course, although there are significant populations of infants with lung disease at risk for this diagnosis. Contributing cardiovascular comorbidities are common in infants with pulmonary hypertension and lung disease. It is not clear who should be treated without confirmation of pulmonary vascular disease by cardiac catheterization, with concurrent evaluation of any contributing cardiovascular comorbidities.
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Affiliation(s)
- Roberta L Keller
- Neonatology, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, Box 0734, 550 16th Street, 5th Floor, San Francisco, CA 94143, USA.
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14
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Zenitani M, Nojiri T, Uehara S, Miura K, Hosoda H, Kimura T, Nakahata K, Miyazato M, Okuyama H, Kangawa K. C-type natriuretic peptide in combination with sildenafil attenuates proliferation of rhabdomyosarcoma cells. Cancer Med 2016; 5:795-805. [PMID: 26816265 PMCID: PMC4864809 DOI: 10.1002/cam4.642] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/20/2015] [Accepted: 12/21/2015] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumor and the most common soft tissue sarcoma in children. Because of several complications associated with intensive multimodal therapies, including growth disturbance and secondary cancer, novel therapies with less toxicity are urgently needed. C‐type natriuretic peptide (CNP), an endogenous peptide secreted by endothelial cells, exerts antiproliferative effects in multiple types of mesenchymal cells. Therefore, we investigated whether CNP attenuates proliferation of RMS cells. We examined RMS patient samples and RMS cell lines. All RMS clinical samples expressed higher levels of guanylyl cyclase B (GC‐B), the specific receptor for CNP, than RMS cell lines. GC‐B expression in RMS cells decreased with the number of passages in vitro. Therefore, GC‐B stable expression lines were established to mimic clinical samples. CNP increased cyclic guanosine monophosphate (cGMP) levels in RMS cells in a dose‐dependent manner, demonstrating the biological activity of CNP. However, because cGMP is quickly degraded by phosphodiesterases (PDEs), the selective PDE5 inhibitor sildenafil was added to inhibit its degradation. In vitro, CNP, and sildenafil synergistically inhibited proliferation of RMS cells stably expressing GC‐B and decreased Raf‐1, Mitogen‐activated protein kinase kinase (MEK), and extracellular signal‐regulated kinase (ERK) phosphorylation. These results suggested that CNP in combination with sildenafil exerts antiproliferative effects on RMS cells by inhibiting the Raf/MEK/ERK pathway. This regimen exerted synergistic effects on tumor growth inhibition without severe adverse effects in vivo such as body weight loss. Thus, CNP in combination with sildenafil represents a promising new therapeutic approach against RMS.
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Affiliation(s)
- Masahiro Zenitani
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan.,Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita-City, Osaka, Japan
| | - Takashi Nojiri
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita-City, Osaka, Japan
| | - Koichi Miura
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan
| | - Hiroshi Hosoda
- Departments of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan
| | - Toru Kimura
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan
| | - Kengo Nakahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita-City, Osaka, Japan
| | - Mikiya Miyazato
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita-City, Osaka, Japan
| | - Kenji Kangawa
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita-City, Osaka, Japan
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15
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Hopper RK, Abman SH, Ivy DD. Persistent Challenges in Pediatric Pulmonary Hypertension. Chest 2016; 150:226-36. [PMID: 26836930 DOI: 10.1016/j.chest.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/31/2015] [Accepted: 01/09/2016] [Indexed: 01/18/2023] Open
Abstract
Pulmonary hypertension and related pulmonary vascular diseases cause significant morbidities and high mortality and present many unique challenges toward improving outcomes in neonates, infants, and children. Differences between pediatric and adult disease are reflected in controversies regarding etiologies, classification, epidemiology, diagnostic evaluations, and therapeutic interventions. This brief review highlights several key topics reflecting recent advances in the field and identifies persistent gaps in our understanding of clinical pediatric pulmonary hypertension.
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Affiliation(s)
- Rachel K Hopper
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Steven H Abman
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - D Dunbar Ivy
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
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16
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Dodgen AL, Hill KD. Safety and tolerability considerations in the use of sildenafil for children with pulmonary arterial hypertension. DRUG HEALTHCARE AND PATIENT SAFETY 2015; 7:175-83. [PMID: 26719728 PMCID: PMC4687613 DOI: 10.2147/dhps.s65571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sildenafil is a phosphodiesterase type-5 inhibitor approved for treatment of pulmonary arterial hypertension (PAH) in adults. Data from pediatric trials demonstrate a similar acute safety profile to the adult population but have raised concerns regarding the safety of long-term use in children. Interpretation of these trials remains controversial with major regulatory agencies differing in their recommendations – the US Food and Drug Administration recommends against the use of sildenafil for treatment of PAH in children, while the European Medicines Agency supports its use at “low doses”. Here, we review the available pediatric data regarding dosing, acute, and long-term safety and efficacy of sildenafil for the treatment of PAH in children.
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Affiliation(s)
- Andrew L Dodgen
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA ; Duke Clinical Research Institute, Durham, NC, USA
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17
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Aagaard L. Off-Label and Unlicensed Prescribing of Medicines in Paediatric Populations: Occurrence and Safety Aspects. Basic Clin Pharmacol Toxicol 2015; 117:215-8. [DOI: 10.1111/bcpt.12445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lise Aagaard
- Institute of Public Health; Clinical Pharmacology; Faculty of Health Sciences; University of Southern Denmark; J.B. Winsløws Vej 19 DK-5000 Odense C. Denmark
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18
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Beghetti M, Lador F. Editorial: Pediatric Pulmonary Hypertension. Front Pediatr 2015; 3:105. [PMID: 26649287 PMCID: PMC4663240 DOI: 10.3389/fped.2015.00105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- Maurice Beghetti
- Pediatric Cardiology Unit, Children's University Hospital, University of Geneva , Geneva , Switzerland ; Pulmonary Hypertension Program, University of Geneva , Geneva , Switzerland
| | - Frederic Lador
- Pulmonary Hypertension Program, University of Geneva , Geneva , Switzerland ; Division of Pneumology, University of Geneva , Geneva , Switzerland
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