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Alvi SB, Pracha N, Shalaan M, Dholaniya PS, Mergaye M, Sridharan D, Khan M. Fabrication and Optimization of Poly(ε-caprolactone) Microspheres Loaded with S-Nitroso-N-Acetylpenicillamine for Nitric Oxide Delivery. Biomedicines 2024; 12:1363. [PMID: 38927571 PMCID: PMC11201505 DOI: 10.3390/biomedicines12061363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Heart disease is one of the leading causes of death in the United States and throughout the world. While there are different techniques for reducing or preventing the impact of heart disease, nitric oxide (NO) is administered as nitroglycerin for reversing angina or chest pain. Unfortunately, due to its gaseous and short-lived half-life, NO can be difficult to study or even administer. Therefore, controlled delivery of NO is desirable for therapeutic use. In the current study, the goal was to fabricate NO-releasing microspheres (MSs) using a donor molecule, S-Nitroso-N-Acetyl penicillamine, (SNAP), and encapsulating it in poly(ε-caprolactone) (PCL) using a single-emulsion technique that can provide sustained delivery of NO to cells over time without posing any toxicity risks. Optimization of the fabrication process was performed by varying the duration of homogenization (5, 10, and 20 min) and its effect on entrapment efficiency and size. The optimized SNAP-MS had an entrapment efficiency of ˃50%. Furthermore, we developed a modified method for NO detection by using NO microsensors to detect the NO release from SNAP-MSs in real time, showing sustained release behavior. The fabricated SNAP-MSs were tested for biocompatibility with HUVECs (human umbilical vein endothelial cells), which were found to be biocompatible. Lastly, we tested the effect of controlled NO delivery to human induced pluripotent stem-derived cardiomyocytes (hiPSC-CMs) via SNAP-MSs, which showed a significant improvement in the electrophysiological parameters and alleviated anoxic stress.
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Affiliation(s)
- Syed Baseeruddin Alvi
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Nooruddin Pracha
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Mahmoud Shalaan
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Pankaj Singh Dholaniya
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Muhamad Mergaye
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Divya Sridharan
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Mahmood Khan
- Division of Basic and Translational Research, Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH 43210, USA
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH 43210, USA
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2
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Oh Y, Park K, Jung S, Choi M, Kim T, Lee Y, Choi JY, Kim YH, Jung SY, Hong J. Inhalable Nitric Oxide Delivery Systems for Pulmonary Arterial Hypertension Treatment. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2308936. [PMID: 38054614 DOI: 10.1002/smll.202308936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/24/2023] [Indexed: 12/07/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a severe medical condition characterized by elevated blood pressure in the pulmonary arteries. Nitric oxide (NO) is a gaseous signaling molecule with potent vasodilator effects; however, inhaled NO is limited in clinical practice because of the need for tracheal intubation and the toxicity of high NO concentrations. In this study, inhalable NO-releasing microspheres (NO inhalers) are fabricated to deliver nanomolar NO through a nebulizer. Two NO inhalers with distinct porous structures are prepared depending on the molecular weights of NO donors. It is confirmed that pore formation can be controlled by regulating the migration of water molecules from the external aqueous phase to the internal aqueous phase. Notably, open porous NO inhalers (OPNIs) can deliver NO deep into the lungs through a nebulizer. Furthermore, OPNIs exhibit vasodilatory and anti-inflammatory effects via sustained NO release. In conclusion, the findings suggest that OPNIs with highly porous structures have the potential to serve as tools for PAH treatment.
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Affiliation(s)
- Yoogyeong Oh
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyungtae Park
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sungwon Jung
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moonhyun Choi
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Taihyun Kim
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yoojin Lee
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Yang-Hee Kim
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, SO16 6YD, UK
| | - Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jinkee Hong
- School of Chemical & Biomolecular Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
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3
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Kaplish D, Vagha JD, Meshram RJ, Lohiya S. A Comprehensive Review of Inhaled Nitric Oxide Therapy: Current Trends, Challenges, and Future Directions. Cureus 2024; 16:e53558. [PMID: 38445143 PMCID: PMC10913844 DOI: 10.7759/cureus.53558] [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: 12/24/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
This comprehensive review explores the multifaceted landscape of inhaled nitric oxide (iNO) therapy, tracing its historical evolution, mechanisms of action, clinical applications, challenges, and future directions. The nitric oxide signaling pathway, characterized by vasodilatory effects and anti-inflammatory properties, forms the foundation of iNO's therapeutic efficacy. Clinical applications are found in neonatal respiratory distress syndrome, pulmonary hypertension, and acute respiratory distress syndrome, showcasing its versatility. However, challenges, including cost considerations, technical intricacies, safety concerns, and resistance, highlight the nuanced landscape surrounding iNO therapy. Implications for clinical practice underscore the need for a tailored and evidence-based approach, considering individual patient characteristics and indications. Recommendations for future research emphasize ongoing exploration, novel indications, and the development of targeted therapies. In conclusion, this review positions iNO as a dynamic and adaptable intervention, poised to reshape therapeutic strategies and enhance patient outcomes in critical care.
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Affiliation(s)
- Divyanshi Kaplish
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sham Lohiya
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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4
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Zhang MQ, Wang CC, Pang XB, Shi JZ, Li HR, Xie XM, Wang Z, Zhang HD, Zhou YF, Chen JW, Han ZY, Zhao LL, He YY. Role of macrophages in pulmonary arterial hypertension. Front Immunol 2023; 14:1152881. [PMID: 37153557 PMCID: PMC10154553 DOI: 10.3389/fimmu.2023.1152881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe cardiopulmonary vascular disease characterized by progressive pulmonary artery pressure elevation, increased pulmonary vascular resistance and ultimately right heart failure. Studies have demonstrated the involvement of multiple immune cells in the development of PAH in patients with PAH and in experimental PAH. Among them, macrophages, as the predominant inflammatory cells infiltrating around PAH lesions, play a crucial role in exacerbating pulmonary vascular remodeling in PAH. Macrophages are generally polarized into (classic) M1 and (alternative) M2 phenotypes, they accelerate the process of PAH by secreting various chemokines and growth factors (CX3CR1, PDGF). In this review we summarize the mechanisms of immune cell action in PAH, as well as the key factors that regulate the polarization of macrophages in different directions and their functional changes after polarization. We also summarize the effects of different microenvironments on macrophages in PAH. The insight into the interactions between macrophages and other cells, chemokines and growth factors may provide important clues for the development of new, safe and effective immune-targeted therapies for PAH.
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Affiliation(s)
- Meng-Qi Zhang
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Chen-Chen Wang
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Xiao-Bin Pang
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Jun-Zhuo Shi
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Hao-Ran Li
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Xin-Mei Xie
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Zhe Wang
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Hong-Da Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Feng Zhou
- School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Ji-Wang Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Zhi-Yan Han
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yang-Yang He, ; Lu-Ling Zhao, ; Zhi-Yan Han,
| | - Lu-Ling Zhao
- School of Pharmacy, Henan University, Kaifeng, Henan, China
- *Correspondence: Yang-Yang He, ; Lu-Ling Zhao, ; Zhi-Yan Han,
| | - Yang-Yang He
- School of Pharmacy, Henan University, Kaifeng, Henan, China
- *Correspondence: Yang-Yang He, ; Lu-Ling Zhao, ; Zhi-Yan Han,
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Jamaiyar A, Chen J, Feinberg MW. Soluble guanylyl cyclase in platelets keeps atherosclerosis at bay. NATURE CARDIOVASCULAR RESEARCH 2022; 1:1124-1126. [PMID: 39196163 DOI: 10.1038/s44161-022-00188-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Affiliation(s)
- Anurag Jamaiyar
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jingshu Chen
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark W Feinberg
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Nanoparticle endothelial delivery of PGC-1α attenuates hypoxia-induced pulmonary hypertension by attenuating EndoMT-caused vascular wall remodeling. Redox Biol 2022; 58:102524. [PMID: 36334380 PMCID: PMC9637961 DOI: 10.1016/j.redox.2022.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
Abstract
Pulmonary hypertension (PH) induced by chronic hypoxia is characterized by thickening of pulmonary artery walls, elevated pulmonary vascular resistance, and right-heart failure. Dysfunction of endothelial cells is the hallmark event in the progression of PH. Among various mechanisms, endothelial to mesenchymal transition (EndoMT) has emerged as an important source of endothelial cell dysfunction in PH. However, the mechanisms underlying the EndoMT in PH remain largely unknown. Our results showed that peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) expression was decreased in pulmonary arterial endothelial cells (PAECs) in PH patients and hypoxia-induced PH mouse model compared to the normal controls. Endothelial-specific overexpression of PGC-1α using nanoparticle delivery significantly attenuated the progression of PH, as shown by the significantly decreased right ventricular systolic pressure and diminished artery thickness as well as reduced vascular muscularization. Moreover, Endothelial-specific overexpression of PGC-1α blocked the EndoMT of PAECs during PH, indicating that loss of PGC-1α promotes PH development by mediating EndoMT, which damages the integrity of endothelium. Intriguingly, we found that PGC-1α overexpression rescued the expression of endothelial nitric oxide synthase in mouse lung tissues that was deceased by hypoxia treatment in vivo and in endothelial cells treated with TGF-β in vitro. Consistently, PAECs and vascular smooth muscle co-culture showed that overexpression of PGC-1α in PAECs increases nitric oxide release, which would likely diffuse to smooth muscle cells, where it activates specific protein kinases, and initiates SMC relaxation by diminishing the calcium flux. Endothelial-specific overexpression of PGC-1α also attenuated hypoxia-induced pulmonary artery stiffness which appeared to be caused by both the decreased endothelial nitric oxide production and increased vascular remodeling. Taken together, these results demonstrated that endothelial-specific delivery of PGC-1α prevents PH development by inhibiting EndoMT of PAECs and thus restoring endothelial function and reducing vascular remodeling.
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7
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Mendel B, Setiawan M, Siagian SN, Prakoso R. Pharmacology Management in Improving Exercise Capacity of Patients with Fontan Circulation: A Systematic Review and Meta-analysis. Curr Cardiol Rev 2022; 18:34-49. [PMID: 35379155 PMCID: PMC9896416 DOI: 10.2174/1573403x18666220404101610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Fontan procedure is currently the mainstay therapy for single functional ventricles. However, with prolonged follow-up duration, various complications have been observed that seriously influence the quality of life of patients. OBJECTIVES The aim of this meta-analysis is to compare the effectiveness of pharmacologic agents in improving exercise capacity in patients with Fontan circulation. METHODS This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and has been registered in the International Prospective Register for Systematic Reviews database with registration no. 282352. Quality assessments of the included studies were assessed using the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS Twelve studies met the predetermined inclusion criteria and were included in this metaanalysis. This meta-analysis found that treatment with bosentan significantly improved New York Heart Association Functional Class (NYHA FC) in Fontan patients (standard mean difference - 0.59, 95% CI -0.94 - -0.25; P=0.0008; I2 = 1%). However, the use of bosentan (P=0.66) and sildenafil (P=0.13) did not show a significant improvement in the maximum rate of oxygen consumption (VO2 max). CONCLUSION This meta-analysis shows that people with Fontan circulation may benefit from using bosentan as it decreases postexercise heart rate and improves NYHA FC and 6-minute walking test results. Therefore, indirectly improving exercise capacity. Nonetheless, considerable work is required to strengthen our knowledge in improving the exercise capacity of Fontan patients.
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Affiliation(s)
- Brian Mendel
- Address correspondence to this author at the Faculty of Medicine, Universitas Indonesia, P.O. Box: 1358, Jakarta, Indonesia; Tel/Fax: +62-131-930-373, +021-390-1814; E-mail:
| | - Christianto1
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Pediatric Cardiology and Congenital Heart Defect Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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8
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The role of immune cells in pulmonary hypertension: Focusing on macrophages. Hum Immunol 2021; 83:153-163. [PMID: 34844784 DOI: 10.1016/j.humimm.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023]
Abstract
Pulmonary hypertension (PH) is a life-threatening pathological state with elevated pulmonary arterial pressure, resulting in right ventricular failure and heart functional failure. Analyses of human samples and rodent models of pH support the infiltration of various immune cells, including neutrophils, mast cells, dendritic cells, B-cells, T-cells, and natural killer cells, to the lungs and pulmonary perivascular regions and their involvement in the PH development. There is evidence that macrophages are presented in the pulmonary lesions of pH patients as first-line myeloid leucocytes. Macrophage accumulation and presence, both M1 and M2 phenotypes, is a distinctive hallmark of pH which plays a pivotal role in pulmonary artery remodeling through various cellular and molecular interactions and mechanisms, including CCL2 and CX3CL1 chemokines, adventitial fibroblasts, glucocorticoid-regulated kinase 1 (SGK1), crosstalk with other immune cells, leukotriene B4 (LTB4), bone morphogenetic protein receptor 2 (BMPR2), macrophage migration inhibitory factor (MIF), and thrombospondin-1 (TSP-1). In this paper, we reviewed the molecular mechanisms and the role of immune cells and responses are involved in PH development. We also summarized the polarization of macrophages in response to different stimuli and their pathological role and their infiltration in the lung of pH patients and animal models.
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Fernandes CJ, Calderaro D, Assad APL, Salibe-Filho W, Kato-Morinaga LT, Hoette S, Piloto B, Castro MA, Lisboa RP, da Silva TAF, Martins MDA, Alves-Jr JL, Jardim C, Terra-Filho M, de Souza R. Update on the Treatment of Pulmonary Arterial Hypertension. Arq Bras Cardiol 2021; 117:750-764. [PMID: 34709302 PMCID: PMC8528352 DOI: 10.36660/abc.20200702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/13/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022] Open
Abstract
In the last decades, important advances have been made in the treatment of pulmonary arterial hypertension (PAH), a severe, progressive, incurable, and potentially fatal disease. For an adequate therapy, correct hemodynamic diagnosis and etiology classification are fundamental. Many etiologies - rheumatic disease, portal hypertension, congenital heart diseases, schistosomiasis - require specific measures, in addition to drug therapy for PAH. The specific therapy for PAH is based on medications that act on three pathophysiological pathways - prostacyclin, endothelin, and nitric oxide pathways. These drugs have multiple presentations (oral, intravenous, subcutaneous, and inhaled) and have changed the history of PAH. This review presents an overview of drug therapy strategies and different forms and peculiarities of PAH.
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Affiliation(s)
- Caio J. Fernandes
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Instituto do CâncerFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Câncer da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Daniela Calderaro
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Medicina Interdisciplinar - Divisão de Cardiologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Ana Paula Luppino Assad
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDisciplina de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - William Salibe-Filho
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luciana Tamie Kato-Morinaga
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Susana Hoette
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Bruna Piloto
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Marcela Araújo Castro
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Roberta Pontes Lisboa
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Taysa Antonia Felix da Silva
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Murillo de Araújo Martins
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Jose L. Alves-Jr
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Instituto do CâncerFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Câncer da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Carlos Jardim
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Mario Terra-Filho
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Rogerio de Souza
- IncorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade de Circulação Pulmonar - Divisão de Pneumologia – Incor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP - Brasil
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10
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Dominic P, Ahmad J, Bhandari R, Pardue S, Solorzano J, Jaisingh K, Watts M, Bailey SR, Orr AW, Kevil CG, Kolluru GK. Decreased availability of nitric oxide and hydrogen sulfide is a hallmark of COVID-19. Redox Biol 2021; 43:101982. [PMID: 34020311 PMCID: PMC8106525 DOI: 10.1016/j.redox.2021.101982] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is involved in a global outbreak affecting millions of people who manifest a variety of symptoms. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is increasingly associated with cardiovascular complications requiring hospitalizations; however, the mechanisms underlying these complications remain unknown. Nitric oxide (NO) and hydrogen sulfide (H2S) are gasotransmitters that regulate key cardiovascular functions. METHODS Blood samples were obtained from 68 COVID-19 patients and 33 controls and NO and H2S metabolites were assessed. H2S and NO levels were compared between cases and controls in the entire study population and subgroups based on race. The availability of gasotransmitters was examined based on severity and outcome of COVID-19 infection. The performance of H2S and NO levels in predicting COVID-19 infection was also analyzed. Multivariable regression analysis was performed to identify the effects of traditional determinants of gasotransmitters on NO and H2S levels in the patients with COVID-19 infection. RESULTS Significantly reduced NO and H2S levels were observed in both Caucasian and African American COVID-19 patients compared to healthy controls. COVID-19 patients who died had significantly higher NO and H2S levels compared to COVID-19 patients who survived. Receiver-operating characteristic analysis of NO and H2S metabolites in the study population showed free sulfide levels to be highly predictive of COVID-19 infection based on reduced availability. Traditional determinants of gasotransmitters, namely age, race, sex, diabetes, and hypertension had no effect on NO and H2S levels in COVID-19 patients. CONCLUSION These observations provide the first insight into the role of NO and H2S in COVID-19 infection, where their low availability may be a result of reduced synthesis secondary to endotheliitis, or increased consumption from scavenging of reactive oxygen species.
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Affiliation(s)
- Paari Dominic
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, LA, United States; Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, LA, United States; Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States.
| | - Javaria Ahmad
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Ruchi Bhandari
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Sibile Pardue
- Department of Pathology, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Juan Solorzano
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Keerthish Jaisingh
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Megan Watts
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Steven R. Bailey
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - A. Wayne Orr
- Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Department of Pathology, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Cellular Biology and Anatomy, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Christopher G. Kevil
- Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Department of Pathology, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Cellular Biology and Anatomy, Louisiana State University Health Sciences Center-Shreveport, LA, United States
| | - Gopi K. Kolluru
- Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Department of Pathology, Louisiana State University Health Sciences Center-Shreveport, LA, United States,Corresponding author. Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, United States.
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11
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Ouyang S, Chen W, Gaofeng Z, Changcheng L, Guoping T, Minyan Z, Yang L, Min Y, Luo J. Cyanidin‑3‑O‑β‑glucoside protects against pulmonary artery hypertension induced by monocrotaline via the TGF‑β1/p38 MAPK/CREB signaling pathway. Mol Med Rep 2021; 23:338. [PMID: 33760143 PMCID: PMC7974420 DOI: 10.3892/mmr.2021.11977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/09/2020] [Indexed: 12/22/2022] Open
Abstract
Pulmonary artery hypertension (PAH) is a disease with high morbidity and mortality. Cyanidin‑3‑O‑β‑glucoside (Cy‑3‑g), a classical anthocyanin, has a variety of biological effects. The present study evaluated whether Cy‑3‑g attenuated PAH, and explored the potential mechanism of action. Rats were injected with monocrotaline (MCT; 60 mg per kg of body weight) and then treated with Cy‑3‑g (200 or 400 mg per kg of body weight) for 4 weeks. Protein expression was determined in vitro in transforming growth factor‑β1 (TGF‑β1)‑mediated human pulmonary arterial smooth muscle cells (SMCs). The results indicated that Cy‑3‑g significantly inhibited the mean pulmonary artery pressure, right ventricular systolic pressure and right ventricular hypertrophy index, as well as vascular remodeling induced by MCT in PAH rats. Further experiments showed that Cy‑3‑g suppressed the expression of pro‑-inflammatory factors and enhanced the levels of anti‑inflammatory factors. Cy‑3‑g blocked oxidative stress and improved vascular endothelial injury. Cy‑3‑g also reduced the proliferation of SMCs. Furthermore, the MCT‑ and TGF‑β1‑induced increase in TGF‑β1, phosphorylated (p)‑p38 mitogen‑activated protein kinase (MAPK) and p‑cAMP‑response element binding protein (CREB) expression was blocked by Cy‑3‑g treatment in vivo and in vitro. These results indicated that Cy‑3‑g could prevent vascular remodeling in PAH via inhibition of the TGF‑β1/p38 MAPK/CREB axis.
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Affiliation(s)
- Shao Ouyang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Wei Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Zeng Gaofeng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Lei Changcheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Tian Guoping
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Zhu Minyan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Liu Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Yang Min
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Jiahao Luo
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
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12
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IRAG1 Deficient Mice Develop PKG1β Dependent Pulmonary Hypertension. Cells 2020; 9:cells9102280. [PMID: 33066124 PMCID: PMC7601978 DOI: 10.3390/cells9102280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 02/07/2023] Open
Abstract
PKGs are serine/threonine kinases. PKG1 has two isoforms-PKG1α and β. Inositol trisphosphate receptor (IP3R)-associated cGMP-kinase substrate 1 (IRAG1) is a substrate for PKG1β. IRAG1 is also known to further interact with IP3RI, which mediates intracellular Ca2+ release. However, the role of IRAG1 in PH is not known. Herein, WT and IRAG1 KO mice were kept under normoxic or hypoxic (10% O2) conditions for five weeks. Animals were evaluated for echocardiographic variables and went through right heart catheterization. Animals were further sacrificed to prepare lungs and right ventricular (RV) for immunostaining, western blotting, and pulmonary artery smooth muscle cell (PASMC) isolation. IRAG1 is expressed in PASMCs and downregulated under hypoxic conditions. Genetic deletion of IRAG1 leads to RV hypertrophy, increase in RV systolic pressure, and RV dysfunction in mice. Absence of IRAG1 in lung and RV have direct impacts on PKG1β expression. Attenuated PKG1β expression in IRAG1 KO mice further dysregulates other downstream candidates of PKG1β in RV. IRAG1 KO mice develop PH spontaneously. Our results indicate that PKG1β signaling via IRAG1 is essential for the homeostasis of PASMCs and RV. Disturbing this signaling complex by deleting IRAG1 can lead to RV dysfunction and development of PH in mice.
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13
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Lymph-directed nitric oxide increases immune cell access to lymph-borne nanoscale solutes. Biomaterials 2020; 265:120411. [PMID: 33080460 DOI: 10.1016/j.biomaterials.2020.120411] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022]
Abstract
Lymph nodes (LNs) are immune organs housing high concentrations of lymphocytes, making them critical targets for therapeutic immunomodulation in a wide variety of diseases. While there is great interest in targeted drug delivery to LNs, many nanoscale drug delivery carriers have limited access to parenchymal resident immune cells compared to small molecules, limiting their efficacy. Nitric oxide (NO) is a potent regulator of vascular and lymphatic transport and a promising candidate for modulating nanocarrier access to LNs, but its lymphatic accumulation is limited by its low molecular weight and high reactivity. In this work, we employ S-nitrosated nanoparticles (SNO-NP), a lymphatic-targeted delivery system for controlled NO release, to investigate the effect of NO application on molecule accumulation and distribution within the LN. We evaluated the LN accumulation, spatial distribution, and cellular distribution of a panel of fluorescent tracers after intradermal administration alongside SNO-NP or a small molecule NO donor. While SNO-NP did not alter total tracer accumulation in draining lymph nodes (dLNs) or affect active cellular transport of large molecules from the injection site, its application enhanced the penetration of nanoscale 30 nm dextrans into the LN and their subsequent uptake by LN-resident lymphocytes, while nontargeted NO delivery did not. These results further extended to a peptide-conjugated NP drug delivery system, which showed enhanced uptake by B cells and dendritic cells when administered alongside SNO-NP. Together, these results highlight the utility of LN-targeted NO application for the enhancement of nanocarrier access to therapeutically relevant LN-resident immune cells, making NO a potentially useful tool for improving LN drug delivery and immune responses.
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Rahman T, Faisal ARM, Khanam T, Shekhar HU. Recurrent Indoor Environmental Pollution and Its Impact on Health and Oxidative Stress of the Textile Workers in Bangladesh. ENVIRONMENTAL HEALTH INSIGHTS 2020; 14:1178630220938393. [PMID: 32843838 PMCID: PMC7418231 DOI: 10.1177/1178630220938393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
Perennial indoor environmental pollution in the textile industrial area is a potential health hazard for workers engaged in this line of work, resulting in mental aberration to severe health risks. This study was designed to investigate the indoor environmental quality of textile industries and correlate its effect on the occupational health and well-being of the textile workers by measuring plasma oxidative stress status in textile workers and healthy control subjects. Environmental samples were collected from 15 textile industries located in Dhaka division, and 30 volunteer textile workers and 30 volunteer office workers (control) aged 18 to 57 years participated in the study. The concentration of plasma ascorbic acid (P-ASC), plasma malondialdehyde (P-MDA), and plasma conjugated diene (P-CD) was measured in both groups. The noise level (78.0 ± 0.68 dB) and the formaldehyde level (141.80 ± 4.47 µg/m3) were found to be significantly higher in the indoor environmental area compared with those in the control area (70.17 ± 0.25 dB and 108.0 ± 0.76 µg/m3, respectively). Furthermore, the daily average concentration of suspended particulate matters (PMs), that is, PM2.5 (322.2 ± 13.46 µg/m3) and PM10 (411.0 ± 17.57 µg/m3), was also found to be significantly higher in the indoor environmental air compared with that in the control area (78.59 ± 1.66 and 174.0 ± 2.33 µg/m3, respectively). The levels of P-MDA (0.37 ± 0.03 nmol/L) and P-CD (14.74 ± 0.61 nmol/L) were significantly increased, whereas the level of P-ASC level (0.46 ± 0.04 mg/dL) was markedly decreased in the textile workers compared with the healthy control subjects (0.18 ± 0.01 nmol/L of P-MDA, 10.04 ± 0.44 nmol/L of P-CD, and 1.29 ± 0.06 mg/dL of P-ASC). The textile plants were found to have significantly elevated levels of indoor environmental pollutants compared with those in the control area, and the textile workers were significantly exposed to oxidative stresses compared with the control subjects. The use of noise pads and high-efficiency air filters is perhaps highly instrumental to put an end to this prevailing situation. Moreover, to overcome the oxidative stresses among workers, supplementation of antioxidant vitamins (ie, ascorbic acid and/or vitamin E) may be beneficial. In addition, to prevent serious health-related issues, proper precautions should be taken to protect the occupational health of the textile workers.
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Affiliation(s)
- Tania Rahman
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Ar-Rafi Md. Faisal
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Tahura Khanam
- Qtex Solutions Limited, 1st ISO 17020:2012 Accredited Environmental inspection body in Bangladesh
| | - Hossain Uddin Shekhar
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Dhaka, Dhaka, Bangladesh
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15
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Sztormowska-Achranowicz K, Jankowski Z, Kocić I. Protective effect of nicotinamide and L-arginine against monocrotaline-induced pulmonary hypertension in rats: gender dependence. Pharmacol Rep 2020; 72:1334-1346. [PMID: 32632916 PMCID: PMC7550290 DOI: 10.1007/s43440-020-00125-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022]
Abstract
Background The purpose of this paper was to examine the effects of nicotinamide (ND) and l-arginine (l-ARG) on pulmonary vascular and heart changes induced by pulmonary hypertension in rats in a gender-dependent way. Methods Experiments were performed on male (M) and female (F) rats. PAH was induced via monocrotaline injection (sc, 60/kg B.W.) on day one of the 23-day observational period. After that, the animals were sacrificed, hearts removed and weighed and the papillary muscles isolated to measure force of contraction (Fc). Morphological changes of pulmonary vessels were also examined. Results Mixed diet supplementation with l-ARG + ND prevented highly significant right ventricle enlargement induced by PAH in both, male and female rats. Weight ratios between the right ventricle (RV) on one side and the left ventricle with septum on the other (LV + S) decreased from 0.46 ± 0.016 g to 0.29 ± 0.006 g in males and from 0.63 ± 0.03 g to 0.24 ± 0.008 g in females, n = 6, p < 0.001. Additionally, PAH increased basal contractility in female groups, and each of the diet allocations (l-ARG, ND, and mixed) were found to restore contractility to control values. All diet protocols in male and female restored decreased responsiveness of the myocardium to norepinephrine in hearts obtained from rats with PAH and prevented vascular changes observed in pulmonary hypertension (thickness of blood vessels and cell infiltration). Conclusion Our study suggests that l-arginine, nicotinamide or both play a positive role in right ventricle function or the process reducing pulmonary vascular remodeling especially in a gender-independent way.
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Affiliation(s)
| | - Zbigniew Jankowski
- Department of Forensic Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Ivan Kocić
- Department of Pharmacology, Medical University of Gdansk, Gdańsk, Poland.
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16
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Simon E, Bridwell RE, Montrief T, Koyfman A, Long B. Evaluation and management of pulmonary hypertension in the emergency department setting. Am J Emerg Med 2020; 38:1237-1244. [DOI: 10.1016/j.ajem.2020.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/17/2022] Open
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17
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Corliss BA, Delalio LJ, Stevenson Keller TC, Keller AS, Keller DA, Corliss BH, Beers JM, Peirce SM, Isakson BE. Vascular Expression of Hemoglobin Alpha in Antarctic Icefish Supports Iron Limitation as Novel Evolutionary Driver. Front Physiol 2019; 10:1389. [PMID: 31780954 PMCID: PMC6861181 DOI: 10.3389/fphys.2019.01389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022] Open
Abstract
Frigid temperatures of the Southern Ocean are known to be an evolutionary driver in Antarctic fish. For example, many fish have reduced red blood cell (RBC) concentration to minimize vascular resistance. Via the oxygen-carrying protein hemoglobin, RBCs contain the vast majority of the body's iron, which is known to be a limiting nutrient in marine ecosystems. Since lower RBC levels also lead to reduced iron requirements, we hypothesize that low iron availability was an additional evolutionary driver of Antarctic fish speciation. Antarctic Icefish of the family Channichthyidae are known to have an extreme alteration of iron metabolism due to loss of RBCs and two iron-binding proteins, hemoglobin and myoglobin. Loss of hemoglobin is considered a maladaptive trait allowed by relaxation of predator selection since extreme adaptations are required to compensate for the loss of oxygen-carrying capacity. However, iron dependency minimization may have driven hemoglobin loss instead of a random evolutionary event. Given the variety of functions that hemoglobin serves in the endothelium, we suspected the protein corresponding to the 3' truncated Hbα fragment (Hbα-3'f) that was not genetically excluded by icefish may still be expressed as a protein. Using whole mount confocal microscopy, we show that Hbα-3'f is expressed in the vascular endothelium of icefish retina, suggesting this Hbα fragment may still serve an important role in the endothelium. These observations support a novel hypothesis that iron minimization could have influenced icefish speciation with the loss of the iron-binding portion of Hbα in Hbα-3'f, as well as hemoglobin β and myoglobin.
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Affiliation(s)
- Bruce A Corliss
- Biomedical Engineering Department, University of Virginia, Charlottesville, VA, United States
| | - Leon J Delalio
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - T C Stevenson Keller
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, United States.,Department of Molecular Physiology and Biophysics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Alexander S Keller
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Bruce H Corliss
- Graduate School of Oceanography, University of Rhode Island, Kingston, RI, United States
| | - Jody M Beers
- Department of Biology, College of Charleston, Charleston, SC, United States
| | - Shayn M Peirce
- Biomedical Engineering Department, University of Virginia, Charlottesville, VA, United States
| | - Brant E Isakson
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, United States.,Department of Molecular Physiology and Biophysics, University of Virginia School of Medicine, Charlottesville, VA, United States
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18
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Malikova E, Carlström M, Kmecova Z, Marusakova M, Zsigmondova B, Krenek P, Klimas J, Henrohn D. Effects of inorganic nitrate in a rat model of monocrotaline-induced pulmonary arterial hypertension. Basic Clin Pharmacol Toxicol 2019; 126:99-109. [PMID: 31429204 DOI: 10.1111/bcpt.13309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/11/2019] [Indexed: 12/27/2022]
Abstract
The nitrate-nitrite-nitric oxide (NO) pathway represents an alternative source of NO generation, which is independent of NO synthase and potentiated by hypoxia. Augmentation of this pathway by dietary nitrate has proven favourable effects in several cardiovascular disease models. However, less is known regarding its potential value in pulmonary arterial hypertension (PAH). The aim of this study was to assess the effects of oral inorganic nitrate administration in monocrotaline (MCT)-induced PAH. Male 12-week-old Wistar rats were injected subcutaneously with monocrotaline (MCT, 60 mg/kg). Nitrate treatment (0.3 or 1 mmol/kg/d; drinking water) commenced on day 12 following the MCT injection and continued for 16 days. Nitrate administration did not attenuate right ventricular (RV) hypertrophy, increased lung weight and up-regulated mRNA expression of brain natriuretic peptide. Plasma nitrate and nitrite levels were significantly increased as well as lung nitrate level, whereas nitrite lung level was decreased following nitrate treatment (1 mmol/kg/d). MCT-induced PAH resulted in an increased MnSOD protein level, which was not observed following nitrate treatment. MCT-associated up-regulation of nNOS in the lung appeared to be dose-dependently prevented by nitrate treatment. Western blot analysis did not reveal any differences in eNOS, iNOS, XO or gp91phox expression in the lungs among the groups. In conclusion, nitrate treatment did not significantly attenuate pathological RV and lung remodelling in the rat MCT model of PAH. The suppression of MnSOD and nNOS expression by nitrate could be interpreted as reduced demand of endogenous antioxidant defence in this model.
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Affiliation(s)
- Eva Malikova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Mattias Carlström
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Zuzana Kmecova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Margareta Marusakova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Bianka Zsigmondova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Peter Krenek
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Jan Klimas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Dan Henrohn
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Sun XZ, Li SY, Tian XY, Hong Z, Li JX. Effect of Rho kinase inhibitor fasudil on the expression ET-1 and NO in rats with hypoxic pulmonary hypertension. Clin Hemorheol Microcirc 2019; 71:3-8. [PMID: 29660902 DOI: 10.3233/ch-160232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Xing-Zhen Sun
- Department of Pediatrics, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China
| | - Shu-Yan Li
- Department of Ophthalmology, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China
| | - Xiang-Yang Tian
- Department of Neurology, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China
| | - Ze Hong
- Department of Pediatrics, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China
| | - Jia-Xin Li
- Department of Pediatrics, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China
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Abstract
BACKGROUND Pulmonary hypertension (PH) comprises a group of complex and heterogenous conditions, characterised by elevated pulmonary artery pressure, and which left untreated leads to right-heart failure and death. PH includes World Health Organisation (WHO) Group 1 pulmonary arterial hypertension (PAH); Group 2 consists of PH due to left-heart disease (PH-LHD); Group 3 comprises PH as a result of lung diseases or hypoxia, or both; Group 4 includes PH due to chronic thromboembolic occlusion of pulmonary vasculature (CTEPH), and Group 5 consists of cases of PH due to unclear and/or multifactorial mechanisms including haematological, systemic, or metabolic disorders. Phosphodiesterase type 5 (PDE5) inhibitors increase vasodilation and inhibit proliferation. OBJECTIVES To determine the efficacy of PDE5 inhibitors for pulmonary hypertension in adults and children. SEARCH METHODS We performed searches of CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science up to 26 September 2018. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. SELECTION CRITERIA We included randomised controlled trials that compared any PDE5 inhibitor versus placebo, or any other PAH disease-specific therapies, for at least 12 weeks. We include separate analyses for each PH group. DATA COLLECTION AND ANALYSIS We imported studies identified by the search into a reference manager database. We retrieved the full-text versions of relevant studies, and two review authors independently extracted data. Primary outcomes were: change in WHO functional class, six-minute walk distance (6MWD), and mortality. Secondary outcomes were haemodynamic parameters, quality of life/health status, dyspnoea, clinical worsening (hospitalisation/intervention), and adverse events. When appropriate, we performed meta-analyses and subgroup analyses by severity of lung function, connective tissue disease diagnosis, and radiological pattern of fibrosis. We assessed the evidence using the GRADE approach and created 'Summary of findings' tables. MAIN RESULTS We included 36 studies with 2999 participants (with pulmonary hypertension from all causes) in the final review. Trials were conducted for 14 weeks on average, with some as long as 12 months. Two trials specifically included children.Nineteen trials included group 1 PAH participants. PAH participants treated with PDE5 inhibitors were more likely to improve their WHO functional class (odds ratio (OR) 8.59, 95% confidence interval (CI) 3.95 to 18.72; 4 trials, 282 participants), to walk 48 metres further in 6MWD (95% CI 40 to 56; 8 trials, 880 participants), and were 22% less likely to die over a mean duration of 14 weeks (95% CI 0.07 to 0.68; 8 trials, 1119 participants) compared to placebo (high-certainty evidence). The number needed to treat to prevent one additional death was 32 participants. There was an increased risk of adverse events with PDE5 inhibitors, especially headache (OR 1.97, 95% CI 1.33 to 2.92; 5 trials, 848 participants), gastrointestinal upset (OR 1.63, 95% CI 1.07 to 2.48; 5 trials, 848 participants), flushing (OR 4.12, 95% CI 1.83 to 9.26; 3 trials, 748 participants), and muscle aches and joint pains (OR 2.52, 95% CI 1.59 to 3.99; 4 trials, 792 participants).Data comparing PDE5 inhibitors to placebo whilst on other PAH-specific therapy were limited by the small number of included trials. Those PAH participants on PDE5 inhibitors plus combination therapy walked 19.66 metres further in six minutes (95% CI 9 to 30; 4 trials, 509 participants) compared to placebo (moderate-certainty evidence). There were limited trials comparing PDE5 inhibitors directly with other PAH-specific therapy (endothelin receptor antagonists (ERAs)). Those on PDE5 inhibitors walked 49 metres further than on ERAs (95% CI 4 to 95; 2 trials, 36 participants) (low-certainty evidence). There was no evidence of a difference in WHO functional class or mortality across both treatments.Five trials compared PDE5 inhibitors to placebo in PH secondary to left-heart disease (PH-LHD). The quality of data were low due to imprecision and inconsistency across trials. In those with PH-LHD there were reduced odds of an improvement in WHO functional class using PDE5 inhibitors compared to placebo (OR 0.53, 95% CI 0.32 to 0.87; 3 trials, 285 participants), and those using PDE5 inhibitors walked 34 metres further compared to placebo (95% CI 23 to 46; 3 trials, 284 participants). There was no evidence of a difference in mortality. Five trials compared PDE5 inhibitors to placebo in PH secondary to lung disease/hypoxia, mostly in COPD. Data were of low quality due to imprecision of effect and inconsistency across trials. There was a small improvement of 27 metres in 6MWD using PDE5 inhibitors compared to placebo in those with PH due to lung disease. There was no evidence of worsening hypoxia using PDE5 inhibitors, although data were limited. Three studies compared PDE5 inhibitors to placebo or other PAH-specific therapy in chronic thromboembolic disease. There was no significant difference in any outcomes. Data quality was low due to imprecision of effect and heterogeneity across trials. AUTHORS' CONCLUSIONS PDE5 inhibitors appear to have clear beneficial effects in group 1 PAH. Sildenafil, tadalafil and vardenafil are all efficacious in this clinical setting, and clinicians should consider the side-effect profile for each individual when choosing which PDE5 inhibitor to prescribe.While there appears to be some benefit for the use of PDE5 inhibitors in PH-left-heart disease, it is not clear based on the mostly small, short-term studies, which type of left-heart disease stands to benefit. These data suggest possible harm in valvular heart disease. There is no clear benefit for PDE5 inhibitors in pulmonary hypertension secondary to lung disease or chronic thromboembolic disease. Further research is required into the mechanisms of pulmonary hypertension secondary to left-heart disease, and cautious consideration of which subset of these patients may benefit from PDE5 inhibitors. Future trials in PH-LHD should be sufficiently powered, with long-term follow-up, and should include invasive haemodynamic data, WHO functional class, six-minute walk distance, and clinical worsening.
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Affiliation(s)
- Hayley Barnes
- The Alfred HospitalDepartment of Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Zoe Brown
- St Vincent's HospitalMelbourneAustralia
| | | | - Trevor Williams
- The Alfred HospitalDepartment of Respiratory MedicineCommercial RdMelbourneAustralia3004
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Foderaro AE, Baird GL, Bazargan-Lari A, Morrissey PE, Gohh RY, Poppas A, Klinger JR, Ventetuolo CE. Echocardiographic Pulmonary Hypertension Predicts Post-transplantation Renal Allograft Failure. Transplant Proc 2017; 49:1256-1261. [PMID: 28735990 PMCID: PMC5567835 DOI: 10.1016/j.transproceed.2017.01.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulmonary hypertension in the setting of renal transplantation has been associated with early allograft dysfunction and increased mortality, but this relationship has not been extensively studied. METHODS We performed a retrospective cohort study of adult patients who underwent their first renal transplantation in the years 2003-2009 and had pre-transplantation echocardiograms. Pulmonary hypertension was defined as right ventricular systolic pressure ≥40 mm Hg in the absence of left-sided valvular disease and/or left ventricular ejection fraction ≤50%. Eighty-two of 205 patients (40%) met the inclusion criteria. The relationship between pulmonary hypertension and death-censored allograft failure (hemodialysis dependence or retransplantation) and serum creatinine was assessed with the use of Cox hazard regression and generalized mixed models. RESULTS The presence of pulmonary hypertension was associated with a 3-fold increase in the risk of death-censored allograft failure (95% confidence interval, 1.20-7.32; P = .02). Failure rates were 19% at 24 months and 51% at 96 months for those with pulmonary hypertension versus 7% at 24 months and 20% at 86 months for those without pulmonary hypertension (P = .01). Among those without graft failure, there was an increase in creatinine levels after transplantation (P = .01). Effect estimates were unchanged by adjustment for multiple covariates and when pulmonary hypertension was defined as right ventricular systolic pressure ≥36 mm Hg. CONCLUSIONS Pulmonary hypertension before renal transplantation carries a 3-fold increased risk of death-censored allograft failure. The relationship between the pulmonary circulation and renal allograft failure warrants further study.
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Affiliation(s)
- A E Foderaro
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - G L Baird
- Department of Surgery, Brown University School of Public Health, Providence, Rhode Island
| | - A Bazargan-Lari
- Department of Health Services, Policy, and Practice, Alpert Medical School of Brown University, Providence, Rhode Island
| | - P E Morrissey
- Lifespan Biostatistics Core, Lifespan Hospital System, Providence, Rhode Island
| | - R Y Gohh
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - A Poppas
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - J R Klinger
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - C E Ventetuolo
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Internal Medicine, Kaiser Permanente, West Los Angeles, California.
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22
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Akbay NO, Bingol Z, Kiyan E, Karaayvaz EB, Bilge AK, Issever H, Okumus G. Fractional Exhaled Nitric Oxide Measurement in Pulmonary Hypertension: A Follow-Up Study. Clin Appl Thromb Hemost 2017; 24:483-488. [PMID: 28393619 DOI: 10.1177/1076029617702243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension (PH) is a fatal disease although significant improvements in treatment are achieved. Easily implemented and noninvasive prognostic techniques are needed while following-up these patients. The aim was to investigate the role of fractional exhaled nitric oxide (FeNO) in follow-up for patients with PH. In this longitudinal study, patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who were seen in PH Outpatient Clinic, Istanbul Faculty of Medicine, Istanbul University, were enrolled in the study. Echocardiography, 6-minute walking test, brain natriuretic peptide, and FeNO measurements were performed, and World Health Organization functional class was evaluated to all patients at baseline, and third, and sixth months. Right-heart catheterization and pulmonary function tests at the time of diagnosis were recorded. The study comprised 31 patients (23 women, 8 men; mean age: 53.4 ± 17.1 years) with PAH (n = 19) and CTEPH (n = 12) and 80 healthy controls. Patients with PH had lower FeNO values than the control group (16.5 ppb vs 19.8 ppb; P < .05). Fractional exhaled nitric oxide values did not change during follow-up and did not correlate with other follow-up measures except tricuspid annular plane systolic excursion values. Fractional exhaled nitric oxide was higher in the idiopathic PAH subgroup at baseline and at third month than patients with PAH associated with other diseases. Fractional exhaled nitric oxide did not change in patients who had clinical deterioration. As a conclusion; Patients with PH had lower FeNO values than healthy controls, but FeNO did not change significantly during follow-up. Large-scale studies with prolonged follow-up periods are needed to understand the role of FeNO in the follow-up of the patients with PH.
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Affiliation(s)
- Nilay Orak Akbay
- 1 Istanbul Medical Faculty, Pulmonary Medicine, Istanbul University, Istanbul, Turkey
| | - Zuleyha Bingol
- 1 Istanbul Medical Faculty, Pulmonary Medicine, Istanbul University, Istanbul, Turkey
| | - Esen Kiyan
- 1 Istanbul Medical Faculty, Pulmonary Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ahmet Kaya Bilge
- 2 Istanbul Medical Faculty, Cardiology, Istanbul University, Istanbul, Turkey
| | - Halim Issever
- 3 Istanbul Medical Faculty, Public Health, Istanbul University, Istanbul, Turkey
| | - Gulfer Okumus
- 1 Istanbul Medical Faculty, Pulmonary Medicine, Istanbul University, Istanbul, Turkey
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Barnes H, Brown Z, Burns A, Williams T. Phosphodiesterase 5 inhibitors for pulmonary hypertension. Cochrane Database Syst Rev 2017; 2017:CD012621. [PMCID: PMC6478235 DOI: 10.1002/14651858.cd012621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the efficacy of PDE‐5 inhibitors for pulmonary hypertension in adults and children.
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Affiliation(s)
- Hayley Barnes
- Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Zoe Brown
- St Vincent's HospitalMelbourneAustralia
| | | | - Trevor Williams
- Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
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24
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Wu W, Perrin-Sarrado C, Ming H, Lartaud I, Maincent P, Hu XM, Sapin-Minet A, Gaucher C. Polymer nanocomposites enhance S-nitrosoglutathione intestinal absorption and promote the formation of releasable nitric oxide stores in rat aorta. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2016; 12:1795-1803. [DOI: 10.1016/j.nano.2016.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/08/2016] [Accepted: 05/05/2016] [Indexed: 02/02/2023]
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25
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Park ES, Son HW, Lee AR, Lee SH, Kim AS, Park SE, Cho YW. Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report. Korean J Anesthesiol 2014; 67:133-8. [PMID: 25237451 PMCID: PMC4166386 DOI: 10.4097/kjae.2014.67.2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/11/2013] [Accepted: 07/26/2013] [Indexed: 11/27/2022] Open
Abstract
Neurogenic pulmonary edema (NPE) in brain dead organ donors occurring after an acute central nervous system insult threatens organ preservation of potential organ donors and the outcome of organ donation. Hence the active and immediate management of NPE is critical. In this case, a 50-year-old male was admitted to the intensive care unit (ICU) for organ donation. He was hypoxic due to NPE induced by spontaneous intracerebral hemorrhage and intraventricular hemorrhage. Protective ventilatory management, intermittent recruitment maneuvers, and supportive treatment were maintained in the ICU and the operating room (OR). Despite this management, the hypoxemia worsened after the OR admission. So inhaled nitric oxide (NO) therapy was performed during the operation, and the hypoxic phenomena showed remarkable improvement. The organ retrieval was successfully completed. Therefore, NO inhalation can be helpful in the improvement of hypoxemia caused by NPE in brain dead organ donors during anesthesia for the organ donation.
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Affiliation(s)
- Eun Sun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hee Won Son
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - A-Ran Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - An Suk Kim
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Woo Cho
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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26
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Brunner N, de Jesus Perez VA, Richter A, Haddad F, Denault A, Rojas V, Yuan K, Orcholski M, Liao X. Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery. Pulm Circ 2014; 4:10-24. [PMID: 25006417 DOI: 10.1086/674885] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 09/12/2013] [Indexed: 01/12/2023] Open
Abstract
Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.
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Affiliation(s)
- Nathan Brunner
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Alice Richter
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA
| | - François Haddad
- Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
| | - André Denault
- Division of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vanessa Rojas
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Ke Yuan
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Mark Orcholski
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Xiaobo Liao
- Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, California, USA ; Division of Cardiothoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Yan T, Zhang GX, Li BL, Zhong K, Xu ZY, Han L. Pulmonary Artery Haemodynamic Properties in Patients with Pulmonary Hypertension Secondary to Rheumatic Mitral Stenosis. Heart Lung Circ 2012; 21:782-6. [DOI: 10.1016/j.hlc.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/17/2012] [Indexed: 11/24/2022]
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28
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Fidan V, Alp H, Karaca F, Ozcan A, Ozcan K. Effect of endoscopic sinus surgery on plasma asymmetric dimethylarginine levels in patients with extensive nasal polyposis. J Int Med Res 2012; 40:565-71. [PMID: 22613417 DOI: 10.1177/147323001204000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study examined the effect of endoscopic sinus surgery (ESS) on plasma levels of asymmetric dimethylarginine (ADMA) and mean pulmonary arterial pressure (mPAP) in patients with extensive nasal polyposis (ENP). METHODS Preoperative and 3 month post-ESS plasma levels of ADMA and mPAP were measured in patients with ENP and in age-and gender-matched controls. RESULTS The study included 45 patients with ENP and 31 controls (mean ± SD age 39.4 ± 8.8 and 38.1 ± 9.6 years, respectively). The mean preoperative ADMA level in ENP patients (0.69 ± 0.27 μmol/l) was statistically significantly lower than in the control group (1.08 ± 0.37 μmol/l). The postoperative ADMA level increased significantly in ENP patients (0.97 ± 0.36 μmol/l) versus the preoperative level. Mean preoperative mPAP in ENP patients (25.7 ± 5.4 mmHg) was statistically significantly higher than in the control group (20.8 ± 2.1 mmHg), and ENP patients showed significant decreases in mPAP after (21.9 ± 3.5 mmHg) versus before ESS. CONCLUSION Patients with ENP had lower plasma ADMA levels compared with healthy controls, however ADMA levels and mPAP improved in ENP patients after ESS.
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Affiliation(s)
- V Fidan
- Ear, Nose and Throat Department, Erzurum Education and Research Hospital, Erzurum, Turkey.
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29
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Chen CN, Watson G, Zhao L. Cyclic guanosine monophosphate signalling pathway in pulmonary arterial hypertension. Vascul Pharmacol 2012; 58:211-8. [PMID: 22982057 DOI: 10.1016/j.vph.2012.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 12/19/2022]
Abstract
During the last decade, it emerged that cyclic guanosine monophosphate (cGMP) is a novel drug target for the treatment of pulmonary arterial hypertension (PAH). cGMP regulates many cellular functions, ranging from contractility to growth, of relevance to the disease. Generated from guanylyl cyclases in response to natriuretic peptides or nitric oxide (NO), cGMP transduces its effects through a number of cGMP effectors, including cGMP-regulated phosphodiesterases and protein kinases. Furthermore, the cGMP concentration is modulated by cGMP-degrading phosphodiesterases. Data to date demonstrate that increasing intracellular cGMP through stimulation of GCs, inhibition of PDEs, or both is a valid therapeutic strategy in drug development for PAH. New advances in understanding of cGMP are unravelled, as well as the pathobiology of PAH. cGMP remains an attractive future PAH drug target. This review makes a more detailed examination of cGMP signalling with particular reference to PAH.
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Affiliation(s)
- Chien-nien Chen
- Experimental Medicine, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
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30
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Ryoo S, Berkowitz DE, Lim HK. Endothelial arginase II and atherosclerosis. Korean J Anesthesiol 2011; 61:3-11. [PMID: 21860744 PMCID: PMC3155133 DOI: 10.4097/kjae.2011.61.1.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 01/11/2023] Open
Abstract
Atherosclerotic vascular disease is the leading cause of morbidity and mortality in developed countries. While it is a complex condition resulting from numerous genetic and environmental factors, it is well recognized that oxidized low-density lipoprotein produces pro-atherogenic effects in endothelial cells (ECs) by inducing the expression of adhesion molecules, stimulating EC apoptosis, inducing superoxide anion formation and impairing protective endothelial nitric oxide (NO) formation. Emerging evidence suggests that the enzyme arginase reciprocally regulates NO synthase and NO production by competing for the common substrate L-arginine. As oxidized LDL (OxLDL) results in arginase activation/upregulation, it appears to be an important contributor to endothelial dysfunction by a mechanism that involves substrate limitation for endothelial NO synthase (eNOS) and NO synthesis. Additionally, arginase enhances production of reactive oxygen species by eNOS. Arginase inhibition in hypercholesterolemic (ApoE-/-) mice or arginase II deletion (ArgII-/-) mice restores endothelial vasorelaxant function, reduces vascular stiffness and markedly reduces atherosclerotic plaque burden. Furthermore, arginase activation contributes to vascular changes including polyamine-dependent vascular smooth muscle cell proliferation and collagen synthesis. Collectively, arginase may play a key role in the prevention and treatment of atherosclerotic vascular disease.
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Affiliation(s)
- Sungwoo Ryoo
- Division of Biology, Kangwon National University, Chuncheon, Korea
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31
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Ryoo S, Berkowitz DE, Lim HK. Endothelial arginase II and atherosclerosis. Korean J Anesthesiol 2011. [DOI: 10.4097/kjae.2011.60.6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sungwoo Ryoo
- Division of Biology, Kangwon National University, Chuncheon, Korea
| | - Dan E. Berkowitz
- Department of Anesthesiology and Critical Medicine and Biomedical Engineering, The Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | - Hyun Kyo Lim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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