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van der Pol KH, Nijenhuis M, Soree B, de Boer-Veger NJ, Buunk AM, Guchelaar HJ, Risselada A, van Schaik RHN, Swen JJ, Touw D, van der Weide J, van Westrhenen R, Deneer VHM, Houwink EJF, Rongen GA. Dutch pharmacogenetics working group guideline for the gene-drug interaction of ABCG2, HLA-B and Allopurinol, and MTHFR, folic acid and methotrexate. Eur J Hum Genet 2024; 32:155-162. [PMID: 36056234 PMCID: PMC10853275 DOI: 10.1038/s41431-022-01180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
The Dutch Pharmacogenetics Working Group (DPWG) aims to facilitate PGx implementation by developing evidence-based pharmacogenetics guidelines to optimize pharmacotherapy. This guideline describes the gene-drug interaction of ABCG2 with allopurinol, HLA-B with allopurinol, MTHFR with folic acid, and MTHFR with methotrexate, relevant for the treatment of gout, cancer, and rheumatoid arthritis. A systematic review was performed based on which pharmacotherapeutic recommendations were developed. Allopurinol is less effective in patients with the ABCG2 p.(Gln141Lys) variant. In HLA-B*58:01 carriers, the risk of severe cutaneous adverse events associated with allopurinol is strongly increased. The DPWG recommends using a higher allopurinol dose in patients with the ABCG2 p.(Gln141Lys) variant. For HLA-B*58:01 positive patients the DPWG recommends choosing an alternative (for instance febuxostat). The DPWG indicates that another option would be to precede treatment with allopurinol tolerance induction. Genotyping of ABCG2 in patients starting on allopurinol was judged to be 'potentially beneficial' for drug effectiveness, meaning genotyping can be considered on an individual patient basis. Genotyping for HLA-B*58:01 in patients starting on allopurinol was judged to be 'beneficial' for drug safety, meaning it is advised to consider genotyping the patient before (or directly after) drug therapy has been initiated. For MTHFR-folic acid there is evidence for a gene-drug interaction, but there is insufficient evidence for a clinical effect that makes therapy adjustment useful. Finally, for MTHFR-methotrexate there is insufficient evidence for a gene-drug interaction.
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Affiliation(s)
- Karel H van der Pol
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marga Nijenhuis
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.
| | - Bianca Soree
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | | | | | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arne Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daan Touw
- University of Groningen, Groningen Research Institute of Pharmacy, Department of PharmacoTherapy, -Epidemiology and -Economy, Groningen, The Netherlands
| | - Jan van der Weide
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute/PsyQ, Amsterdam, The Netherlands
- Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vera H M Deneer
- Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Nijenhuis M, Soree B, Jama WOM, de Boer-Veger NJ, Buunk AM, Guchelaar HJ, Houwink EJF, Rongen GA, van Schaik RHN, Swen JJ, Touw D, van der Weide J, van Westrhenen R, Deneer VHM, Risselada A. Dutch pharmacogenetics working group (DPWG) guideline for the gene-drug interaction of CYP2D6 and COMT with atomoxetine and methylphenidate. Eur J Hum Genet 2023; 31:1364-1370. [PMID: 36509836 PMCID: PMC10689464 DOI: 10.1038/s41431-022-01262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Pharmacogenetics (PGx) studies the effect of heritable genetic variation on drug response. Clinical adoption of PGx has remained limited, despite progress in the field. To promote implementation, the Dutch Pharmacogenetics Working Group (DPWG) develops evidence-based guidelines on how to optimize pharmacotherapy based on PGx test results. This guideline describes optimization of atomoxetine therapy based on genetic variation in the CYP2D6 gene. The CYP2D6 enzyme is involved in conversion of atomoxetine into the metabolite 4-hydroxyatomoxetine. With decreasing CYP2D6 enzyme activity, the exposure to atomoxetine and the risk of atomoxetine induced side effects increases. So, for patients with genetically absent CYP2D6 enzyme activity (CYP2D6 poor metabolisers), the DPWG recommends to start with the normal initial dose, bearing in mind that increasing this dose probably will not be required. In case of side effects and/or a late response, the DPWG recommends to reduce the dose and check for sustained effectiveness for both poor metabolisers and patients with genetically reduced CYP2D6 enzyme activity (CYP2D6 intermediate metabolisers). Extra vigilance for ineffectiveness is required in patients with genetically increased CYP2D6 enzyme activity (CYP2D6 ultra-rapid metabolisers). No interaction was found between the CYP2D6 and COMT genes and methylphenidate. In addition, no interaction was found between CYP2D6 and clonidine, confirming the suitability of clonidine as a possible alternative for atomoxetine in variant CYP2D6 metabolisers. The DPWG classifies CYP2D6 genotyping as being "potentially beneficial" for atomoxetine. CYP2D6 testing prior to treatment can be considered on an individual patient basis.
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Affiliation(s)
- Marga Nijenhuis
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.
| | - Bianca Soree
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | - Wafa O M Jama
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | | | | | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands
- Department of Family Medicine, Mayo Clinic, Rochester, MIN, USA
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daan Touw
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jan van der Weide
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute/PsyQ, Amsterdam, The Netherlands
- Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vera H M Deneer
- Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Arne Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
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van der Pol KH, Aljofan M, Blin O, Cornel JH, Rongen GA, Woestelandt AG, Spedding M. Drug Repurposing of Generic Drugs: Challenges and the Potential Role for Government. Appl Health Econ Health Policy 2023; 21:831-840. [PMID: 37398987 PMCID: PMC10627937 DOI: 10.1007/s40258-023-00816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/04/2023]
Abstract
Drug repurposing is the process of identifying a new use for an existing drug or active substance in an indication outside the scope of the original indication. Drug repurposing has important advantages including reduced development time and costs, and potentially large societal healthcare cost savings. However, current generic drug repurposing research faces a number of challenges in obtaining research funds. Furthermore, regardless of the success of a repurposing trial, commercial parties often lack interest in pursuing marketing authorisation for financial reasons, and academic researchers lack the knowledge, time and funding. Therefore, the new indication of a repurposed drug often does not make it 'on label'. We propose a large increase in public funding for generic drug repurposing research, including funds for the marketing authorisation process when a trial is successful, and a reduction in the regulatory burden of the marketing authorisation process for repurposed generic drugs.
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Affiliation(s)
- Karel H van der Pol
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mohamad Aljofan
- Department of Biomedical Science, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
- National Laboratory Astana, Nazarbayev University, Astana, 010000, Kazakhstan
| | - Olivier Blin
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Inserm UMR 1106, Marseille, France
| | - Jan H Cornel
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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Ter Heine R, Rongen GA, Roeters van Lennep J, Rutten JHW. Individualized dosing of evinacumab is predicted to yield reductions in drug expenses. J Clin Lipidol 2023; 17:401-405. [PMID: 36967323 DOI: 10.1016/j.jacl.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Evinacumab is a first-in-class inhibitor of angiopoietin-like protein 3 (ANGPTL3) for treatment of the rare disease homozygous familial hypercholesterolemia (HoFH). With projected drug costs of $450,000 per person per year, the question rises if cost-efficacy of evinacumab can be further improved. OBJECTIVES To develop an individualized dosing regimen te reduce drug expenses. METHODS Using the clinical and pharmacological data as provided by the license holder, we developed an alternative dosing regimen in silico based on the principles of reduction of wastage by dosing based on weight bands rather than a linear milligram per kilogram body weight (mg/kg) dosing regimen, as well as dose individualization guided by low density lipoprotein cholesterol (LDL-C) response. RESULTS We found that the average quantity of drug used for a dose could be reduced by 34% without predicted loss in efficacy (LDL-C reduction 24 weeks after treatment initiation). CONCLUSION Dose reductions without compromising efficacy seem feasible. We call for implementation and prospective evaluation of this strategy to reduce treatment costs of HoFH.
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Affiliation(s)
- Rob Ter Heine
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Pharmacy, Nijmegen, The Netherlands (Dr Heine).
| | - Gerard A Rongen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (Dr Rongen and Rutten)
| | - Jeanine Roeters van Lennep
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (Dr Lennep)
| | - Joost H W Rutten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (Dr Rongen and Rutten)
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5
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Harbers VEM, Zwerink LGJM, Rongen GA, Klein WM, van der Vleuten CJM, van Rijnsoever IMP, Gerdsen-Drury L, Flucke UE, Verhoeven BH, de Laat PCJ, van der Horst CMAM, Schultze Kool LJ, Te Loo DMWM. Clinical differences in sirolimus treatment with low target levels between children and adults with vascular malformations - A nationwide trial. Clin Transl Sci 2023; 16:781-796. [PMID: 36824030 PMCID: PMC10176016 DOI: 10.1111/cts.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/14/2023] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
The clinical presentation of patients with slow-flow vascular malformations is very heterogeneous. High clinical burden and subsequent reduced health-related quality of life is something they have in common. There is an unmet medical need for these patients for whom regular treatments like surgery and embolization are either insufficient or technically impossible. Sirolimus has been reported to be effective and overall well-tolerated in most patients. However, the main limitation of sirolimus is the reported high toxicity, especially when target levels of 10-15 ng/mL are being used. We report the results of a phase IIB single-arm open-label clinical trial consisting of 68 (67 in the challenge phase and 68 in the rechallenge phase) evaluable patients (children n = 33 and adults n = 35) demonstrating that treatment with low sirolimus target levels (4-10 ng/mL) is effective in 79.1% of the patients. When sirolimus treatment was stopped, the majority of patients experienced a recurrence of symptoms, supporting prolonged or even lifelong treatment requirement. Adults experienced a higher baseline pain score compared with children, having an estimated marginal mean of 6.2 versus 4.1, p < 0.05; however, they showed a similar decrease to children. Furthermore, the pediatric population experienced less often a sirolimus-related grade I-IV adverse event (35.9% vs. 64.1%, p > 0.05) compared with adults. Additionally, response rates were higher in children compared with adults (93.8% vs. 65.7%, p < 0.05), and children responded faster (28 vs. 91 days, p < 0.05). These results suggest benefits of sirolimus in patients with slow-flow vascular malformations and support its initiation as young as possible.
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Affiliation(s)
- Veroniek E M Harbers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilly G J M Zwerink
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine and Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willemijn M Klein
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carine J M van der Vleuten
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,VASCERN ERN on Rare Multisystemic Vascular Diseases, Healthcare Provider Coordinator: Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Centre de Réference (CRMR) Syndromes de Marfan et apparentés, Paris, France
| | - Ingrid M P van Rijnsoever
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lynda Gerdsen-Drury
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Uta E Flucke
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas H Verhoeven
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter C J de Laat
- Department of Pediatric Oncology, WEVAR-Team Rotterdam Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Chantal M A M van der Horst
- Department of Plastic Reconstructive and Hand Surgery, AVA-Team, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Leo J Schultze Kool
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,VASCERN ERN on Rare Multisystemic Vascular Diseases, Healthcare Provider Coordinator: Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Centre de Réference (CRMR) Syndromes de Marfan et apparentés, Paris, France
| | - D Maroeska W M Te Loo
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatric Hematology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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6
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de Jong ICA, van Herwaarden N, Rongen GA, van der Pol KH. [Cardiovascular risk in gout - Role of allopurinol?]. Ned Tijdschr Geneeskd 2021; 165:D5273. [PMID: 33914423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The treatment of gout is subject to different national and international guidelines. These guidelines differ in the extent to which they consider cardiovascular risk factors when deciding to start allopurinol. Observational studies and limited trial data suggest that treatment with allopurinol may reduce the risk of cardiovascular events in patients with gout. However, at this moment allopurinol remains an unproven strategy. There is need for a large randomized placebo-controlled trial with sufficient power and duration of follow-up.
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Affiliation(s)
- I C A de Jong
- Radboudumc, afd. Farmacologie-toxicologie, Nijmegen
- Contact: I. C.A. de Jong
| | | | - G A Rongen
- Radboudumc, afd. Farmacologie-toxicologie, Nijmegen
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7
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Rongen GA. [G5 can't do without 5G]. Ned Tijdschr Geneeskd 2021; 165:D5427. [PMID: 33793131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the Netherlands, 5 web-based systems co-exist in the public domain to provide relevant pharmacotherapeutic information for physicians, pharmacists and patients. Although these systems provide significant support to prescribers, still much can be improved by implementing modern ICT technology including artificial intelligence to unlock information to assist rational drug prescription.
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Affiliation(s)
- Gerard A Rongen
- Radboudumc, afd. Farmacologie-Toxicologie en Interne Geneeskunde, Nijmegen
- Contact: Gerard A. Rongen
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8
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Frambach SJCM, de Haas R, Smeitink JAM, Rongen GA, Russel FGM, Schirris TJJ. Brothers in Arms: ABCA1- and ABCG1-Mediated Cholesterol Efflux as Promising Targets in Cardiovascular Disease Treatment. Pharmacol Rev 2020; 72:152-190. [PMID: 31831519 DOI: 10.1124/pr.119.017897] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is a leading cause of cardiovascular disease worldwide, and hypercholesterolemia is a major risk factor. Preventive treatments mainly focus on the effective reduction of low-density lipoprotein cholesterol, but their therapeutic value is limited by the inability to completely normalize atherosclerotic risk, probably due to the disease complexity and multifactorial pathogenesis. Consequently, high-density lipoprotein cholesterol gained much interest, as it appeared to be cardioprotective due to its major role in reverse cholesterol transport (RCT). RCT facilitates removal of cholesterol from peripheral tissues, including atherosclerotic plaques, and its subsequent hepatic clearance into bile. Therefore, RCT is expected to limit plaque formation and progression. Cellular cholesterol efflux is initiated and propagated by the ATP-binding cassette (ABC) transporters ABCA1 and ABCG1. Their expression and function are expected to be rate-limiting for cholesterol efflux, which makes them interesting targets to stimulate RCT and lower atherosclerotic risk. This systematic review discusses the molecular mechanisms relevant for RCT and ABCA1 and ABCG1 function, followed by a critical overview of potential pharmacological strategies with small molecules to enhance cellular cholesterol efflux and RCT. These strategies include regulation of ABCA1 and ABCG1 expression, degradation, and mRNA stability. Various small molecules have been demonstrated to increase RCT, but the underlying mechanisms are often not completely understood and are rather unspecific, potentially causing adverse effects. Better understanding of these mechanisms could enable the development of safer drugs to increase RCT and provide more insight into its relation with atherosclerotic risk. SIGNIFICANCE STATEMENT: Hypercholesterolemia is an important risk factor of atherosclerosis, which is a leading pathological mechanism underlying cardiovascular disease. Cholesterol is removed from atherosclerotic plaques and subsequently cleared by the liver into bile. This transport is mediated by high-density lipoprotein particles, to which cholesterol is transferred via ATP-binding cassette transporters ABCA1 and ABCG1. Small-molecule pharmacological strategies stimulating these transporters may provide promising options for cardiovascular disease treatment.
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Affiliation(s)
- Sanne J C M Frambach
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences (S.J.C.M.F., G.A.R., F.G.M.R., T.J.J.S.), Radboud Center for Mitochondrial Medicine (S.J.C.M.F., R.d.H., J.A.M.S., F.G.M.R., T.J.J.S.), Department of Pediatrics (R.d.H., J.A.M.S.), and Department of Internal Medicine, Radboud Institute for Health Sciences (G.A.R.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ria de Haas
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences (S.J.C.M.F., G.A.R., F.G.M.R., T.J.J.S.), Radboud Center for Mitochondrial Medicine (S.J.C.M.F., R.d.H., J.A.M.S., F.G.M.R., T.J.J.S.), Department of Pediatrics (R.d.H., J.A.M.S.), and Department of Internal Medicine, Radboud Institute for Health Sciences (G.A.R.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan A M Smeitink
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences (S.J.C.M.F., G.A.R., F.G.M.R., T.J.J.S.), Radboud Center for Mitochondrial Medicine (S.J.C.M.F., R.d.H., J.A.M.S., F.G.M.R., T.J.J.S.), Department of Pediatrics (R.d.H., J.A.M.S.), and Department of Internal Medicine, Radboud Institute for Health Sciences (G.A.R.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences (S.J.C.M.F., G.A.R., F.G.M.R., T.J.J.S.), Radboud Center for Mitochondrial Medicine (S.J.C.M.F., R.d.H., J.A.M.S., F.G.M.R., T.J.J.S.), Department of Pediatrics (R.d.H., J.A.M.S.), and Department of Internal Medicine, Radboud Institute for Health Sciences (G.A.R.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans G M Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences (S.J.C.M.F., G.A.R., F.G.M.R., T.J.J.S.), Radboud Center for Mitochondrial Medicine (S.J.C.M.F., R.d.H., J.A.M.S., F.G.M.R., T.J.J.S.), Department of Pediatrics (R.d.H., J.A.M.S.), and Department of Internal Medicine, Radboud Institute for Health Sciences (G.A.R.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom J J Schirris
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences (S.J.C.M.F., G.A.R., F.G.M.R., T.J.J.S.), Radboud Center for Mitochondrial Medicine (S.J.C.M.F., R.d.H., J.A.M.S., F.G.M.R., T.J.J.S.), Department of Pediatrics (R.d.H., J.A.M.S.), and Department of Internal Medicine, Radboud Institute for Health Sciences (G.A.R.), Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Nobacht S, Kusters B, Breukink MB, Rongen GA, Cruysberg JRM. Recurrence of paraproteinemic crystalline keratopathy after corneal transplantation: A case of monoclonal gammopathy of ocular significance. Am J Ophthalmol Case Rep 2020; 19:100803. [PMID: 32671285 PMCID: PMC7350135 DOI: 10.1016/j.ajoc.2020.100803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To report the long-term follow-up (12 years) of a 36-year-old male patient with crystalline keratopathy of both eyes, diagnosed with monoclonal gammopathy of undetermined significance (MGUS). Complete ophthalmic, systemic, and corneal immunohistochemical evaluations were performed. Observations Slit-lamp examination revealed bilateral fine iridescent confluent crystalline deposits in all layers of the cornea, both peripherally and centrally. Systemic evaluation revealed abnormal M protein, IgG-kappa type, in blood and urine. Bone marrow aspiration showed a monoclonal plasma cell concentration of 2%. Consequently, the patient was diagnosed with MGUS. Because of progressive bilateral visual loss in the following 10 years, a perforating keratoplasty was performed on the left eye. Immunohistochemical analysis of the native cornea (the corneal button) revealed depositions of the same M protein type as detected in plasma and urine. Electron microscopy showed rhomboid-shaped corneal deposits of various sizes up to 4 μm. Recurrence of crystalline keratopathy was observed 9 months after keratoplasty. The monoclonal protein remained stable and the MGUS did not progress to multiple myeloma nor a related disorder. Conclusions and importance Crystalline keratopathy may be associated with MGUS in otherwise healthy individuals. If the keratopathy causes binocular visual loss, a corneal transplantation may be required. Unfortunately, recurrence of crystalline deposits in the corneal graft may occur within one year. This suggests that patients with vision impairment due to paraproteinemic keratopathy who are diagnosed as MGUS, in fact, have a monoclonal gammopathy of ocular significance (MGOS).
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Affiliation(s)
- Siamak Nobacht
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Benno Kusters
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Myrte B Breukink
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes R M Cruysberg
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
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10
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van den Berg TNAD, Thijssen DHJ, van Mil ACCM, van den Broek PH, Rongen GA, Monajemi H, Deinum J, Riksen NP. Plasma levels of the cardiovascular protective endogenous nucleoside adenosine are reduced in patients with primary aldosteronism without affecting ischaemia-reperfusion injury: A prospective case-control study. Eur J Clin Invest 2019; 49:e13180. [PMID: 31659743 PMCID: PMC6900001 DOI: 10.1111/eci.13180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/04/2019] [Accepted: 10/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with primary aldosteronism (PA) experience more cardiovascular events compared to patients with essential hypertension (EHT), independent from blood pressure levels. In animals, mineralocorticoid receptor antagonists limit ischaemia-reperfusion (IR) injury by increasing extracellular adenosine formation and adenosine receptor stimulation. Adenosine is an endogenous compound with profound cardiovascular protective effects. Firstly, we hypothesized that patients with PA have lower circulating adenosine levels which might contribute to the observed increased cardiovascular risk. Secondly, we hypothesized that by this mechanism, patients with PA are more susceptible to IR compared to patients with EHT. DESIGN In our prospective study in 20 patients with PA and 20 patients with EHT, circulating adenosine was measured using a pharmacological blocker solution that halts adenosine metabolism after blood drawing. Brachial artery flow-mediated dilation (FMD) before and after forearm IR was used as a well-established method to study IR injury. RESULTS Patients with PA had a 33% lower adenosine level compared to patients with EHT (15.3 [13.3-20.4] vs 22.7 [19.4-36.8] nmol/L, respectively, P < .01). The reduction in FMD after IR, however, did not differ between patients with PA and patients with EHT (-1.0 ± 2.9% vs -1.6 ± 1.6%, respectively, P = .52). CONCLUSIONS As adenosine receptor stimulation induces various powerful protective cardiovascular effects, its lower concentration in patients with PA might be an important novel mechanism that contributes to their increased cardiovascular risk. We suggest that modulation of the adenosine metabolism is an exciting novel pharmacological opportunity to limit cardiovascular risk in patients with PA that needs further exploration.
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Affiliation(s)
- T N A Daniëlle van den Berg
- Department of Pharmacology-Toxicology, Radboud university medical center, Nijmegen, The Netherlands.,Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Anke C C M van Mil
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Petra H van den Broek
- Department of Pharmacology-Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Gerard A Rongen
- Department of Pharmacology-Toxicology, Radboud university medical center, Nijmegen, The Netherlands.,Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Houshang Monajemi
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands.,Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Niels P Riksen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
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11
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van Loon LM, Rongen GA, van der Hoeven JG, Veltink PH, Lemson J. β-Blockade attenuates renal blood flow in experimental endotoxic shock by reducing perfusion pressure. Physiol Rep 2019; 7:e14301. [PMID: 31814327 PMCID: PMC6900489 DOI: 10.14814/phy2.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Clinical data suggests that heart rate (HR) control with selective β1-blockers may improve cardiac function during septic shock. However, it seems counterintuitive to start β-blocker infusion in a shock state when organ blood flow is already low or insufficient. Therefore, we studied the effects of HR control with esmolol, an ultrashort- acting β1-selective adrenoceptor antagonist, on renal blood flow (RBF) and renal autoregulation during early septic shock. In 10 healthy sheep, sepsis was induced by continuous i.v. administration of lipopolysaccharide, while maintained under anesthesia and mechanically ventilated. After successful resuscitation of the septic shock with fluids and vasoactive drugs, esmolol was infused to reduce HR with 30% and was stopped 30-min after reaching this target. Arterial and venous pressures, and RBF were recorded continuously. Renal autoregulation was evaluated by the response in RBF to renal perfusion pressure (RPP) in both the time domain and frequency domain. During septic shock, β-blockade with esmolol significantly increased the pressure dependency of RBF to RPP. Stopping esmolol showed the reversibility of the impaired renal autoregulation. Showing that clinical diligence and caution are necessary when treating septic shock with esmolol in the acute phase since esmolol reduced RPP to critical values thereby significantly reducing RBF.
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Affiliation(s)
- Lex M. van Loon
- Cardiovascular and Respiratory Physiology GroupFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of Intensive Care MedicineRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Gerard A. Rongen
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Johannes G. van der Hoeven
- Department of Intensive Care MedicineRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Radboud Center for Infectious diseasesNijmegenThe Netherlands
| | - Peter H. Veltink
- Biomedical Signals and SystemsFaculty of Electrical Engineering, Mathematics and Computer ScienceTechnical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - Joris Lemson
- Department of Intensive Care MedicineRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
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12
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Lunenburg CATC, van der Wouden CH, Nijenhuis M, Crommentuijn-van Rhenen MH, de Boer-Veger NJ, Buunk AM, Houwink EJF, Mulder H, Rongen GA, van Schaik RHN, van der Weide J, Wilffert B, Deneer VHM, Swen JJ, Guchelaar HJ. Dutch Pharmacogenetics Working Group (DPWG) guideline for the gene-drug interaction of DPYD and fluoropyrimidines. Eur J Hum Genet 2019; 28:508-517. [PMID: 31745289 PMCID: PMC7080718 DOI: 10.1038/s41431-019-0540-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 12/21/2022] Open
Abstract
Despite advances in the field of pharmacogenetics (PGx), clinical acceptance has remained limited. The Dutch Pharmacogenetics Working Group (DPWG) aims to facilitate PGx implementation by developing evidence-based pharmacogenetics guidelines to optimize pharmacotherapy. This guideline describes the starting dose optimization of three anti-cancer drugs (fluoropyrimidines: 5-fluorouracil, capecitabine and tegafur) to decrease the risk of severe, potentially fatal, toxicity (such as diarrhoea, hand-foot syndrome, mucositis or myelosuppression). Dihydropyrimidine dehydrogenase (DPD, encoded by the DPYD gene) enzyme deficiency increases risk of fluoropyrimidine-induced toxicity. The DPYD-gene activity score, determined by four DPYD variants, predicts DPD activity and can be used to optimize an individual’s starting dose. The gene activity score ranges from 0 (no DPD activity) to 2 (normal DPD activity). In case it is not possible to calculate the gene activity score based on DPYD genotype, we recommend to determine the DPD activity and adjust the initial dose based on available data. For patients initiating 5-fluorouracil or capecitabine: subjects with a gene activity score of 0 are recommended to avoid systemic and cutaneous 5-fluorouracil or capecitabine; subjects with a gene activity score of 1 or 1.5 are recommended to initiate therapy with 50% the standard dose of 5-fluorouracil or capecitabine. For subjects initiating tegafur: subjects with a gene activity score of 0, 1 or 1.5 are recommended to avoid tegafur. Subjects with a gene activity score of 2 (reference) should receive a standard dose. Based on the DPWG clinical implication score, DPYD genotyping is considered “essential”, therefore directing DPYD testing prior to initiating fluoropyrimidines.
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Affiliation(s)
- Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Marga Nijenhuis
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.
| | | | | | | | - Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan van der Weide
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Bob Wilffert
- Groningen Research Institute of Pharmacy, Department of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vera H M Deneer
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
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13
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Coleman JJ, Samer C, Zeitlinger M, van Agtmael M, Rongen GA, Marquet P, Simon T, Singer D, Manolopoulos VG, Böttiger Y. The European Association for Clinical Pharmacology and Therapeutics—25 years’ young and going strong. Eur J Clin Pharmacol 2019; 75:743-750. [DOI: 10.1007/s00228-019-02690-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
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14
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Esselink AC, Bril LM, Langenhuijsen RW, Bilos A, Riksen NP, Rongen GA. Effect of two dosages of sodium chloride intake on the blood pressure response to caffeinated coffee in humans in vivo. Int J Food Sci Nutr 2019; 70:1014-1019. [DOI: 10.1080/09637486.2019.1595541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Anne C. Esselink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisanne M. Bril
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renée W. Langenhuijsen
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert Bilos
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels P. Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A. Rongen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Disveld IJM, Fransen J, Rongen GA, Kienhorst LBE, Zoakman S, Janssens HJEM, Janssen M. Crystal-proven Gout and Characteristic Gout Severity Factors Are Associated with Cardiovascular Disease. J Rheumatol 2018; 45:858-863. [PMID: 29657151 DOI: 10.3899/jrheum.170555] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our aim was to examine the prevalence of cardiovascular disease (CVD) in patients with crystal-proven gout compared to arthritis controls. Further, we analyzed the association between characteristic gout severity factors and CVD to provide further support for a pathogenetic relationship between gout and CVD. METHODS Patients with arthritis referred for diagnosis were consecutively included in the Gout Arnhem-Liemers cohort. Joint fluid analysis was performed in all referred patients; controls were negative for crystals. Patients' characteristics and different manifestations of CVD and gout severity factors (disease duration, attack frequency, tophi, affected joints, high serum urate acid level, joint damage) were collected. Gout patients were compared with controls for the prevalence of CVD. In addition, the association between characteristic gout severity factors and presence of CVD was analyzed. RESULTS Data from 700 gout patients and 276 controls were collected. CVD was present in 47% (95% CI 44%-51%) and 24% (95% CI 19%-29%) of gout patients and controls, respectively. Corrected for confounders, gout was still strongly associated with an increased prevalence of CVD compared to controls (OR 3.39, 95% CI 2.37-4.84). In patients with gout, disease duration ≥ 2 years, oligo- or polyarthritis, serum urate acid > 0.55 mmol/l at presentation, and joint damage were independently (p < 0.05) associated with prevalent CVD. CONCLUSION Crystal-proven gout was strongly associated with an increased prevalence of CVD. In patients with gout, characteristic gout severity factors were associated with CVD.
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Affiliation(s)
- Iris J M Disveld
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Jaap Fransen
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Gerard A Rongen
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Laura B E Kienhorst
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Sahel Zoakman
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Hein J E M Janssens
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Matthijs Janssen
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands. .,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital.
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16
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Swen JJ, Nijenhuis M, van Rhenen M, de Boer-Veger NJ, Buunk AM, Houwink EJF, Mulder H, Rongen GA, van Schaik RHN, van der Weide J, Wilffert B, Deneer VHM, Guchelaar HJ. Pharmacogenetic Information in Clinical Guidelines: The European Perspective. Clin Pharmacol Ther 2018; 103:795-801. [PMID: 29460273 DOI: 10.1002/cpt.1049] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 12/13/2022]
Abstract
Surveys among pharmacists and physicians show that these healthcare professionals have successfully adopted the concept of pharmacogenomics (PGx).1-3 In addition, patients are willing to consent to participate in PGx implementation studies.4 However, the surveys also show that healthcare professionals do not frequently order or recommend a PGx test.1,2 Among others, a frequently perceived hurdle for clinical uptake of PGx is the availability of guidelines translating PGx test results into clinical actions for individual patients.5,6.
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Affiliation(s)
- Jesse J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands.,Leiden Network for Personalised Therapeutics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marga Nijenhuis
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | - Mandy van Rhenen
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | | | | | - Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan van der Weide
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen and Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Vera H M Deneer
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands.,Leiden Network for Personalised Therapeutics, Leiden University Medical Centre, Leiden, The Netherlands
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17
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Rongen GA, van Ingen I, Kok M, Vonkeman H, Janssen M, Jansen TL. Vasodilator function worsens after cessation of tumour necrosis factor inhibitor therapy in patients with rheumatoid arthritis only if a flare occurs. Clin Rheumatol 2018; 37:909-916. [DOI: 10.1007/s10067-017-3961-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
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18
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Kiers D, van der Heijden WA, van Ede L, Gerretsen J, de Mast Q, van der Ven AJ, El Messaoudi S, Rongen GA, Gomes M, Kox M, Pickkers P, Riksen NP. A randomised trial on the effect of anti-platelet therapy on the systemic inflammatory response in human endotoxaemia. Thromb Haemost 2017; 117:1798-1807. [PMID: 28692111 DOI: 10.1160/th16-10-0799] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 05/25/2017] [Indexed: 01/09/2023]
Abstract
The use of acetylsalicylic acid (ASA) is associated with improved outcome in patients with sepsis, and P2Y12 inhibitors have been suggested to also have immunomodulatory effects. Therefore, we evaluated the effects of clinically relevant combinations of antiplatelet therapy on the immune response in experimental endotoxaemia in humans in vivo. Forty healthy subjects were randomised to seven days of placebo, placebo with ASA, ticagrelor and ASA, or clopidogrel and ASA treatment. Systemic inflammation was elicited at day seven by intravenous administration of Escherichia coli endotoxin. ASA treatment profoundly augmented the plasma concentration of pro-inflammatory cytokines, but did not affect anti-inflammatory cytokines. Addition of either P2Y12 antagonist to ASA did not affect any of the circulating cytokines, except for an attenuation of the ASA-induced increase in TNFα by ticagrelor. Systemic inflammation increased plasma adenosine, without differences between groups, and although P2Y12 inhibition impaired platelet reactivity, there was no correlation with cytokine responses.
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Affiliation(s)
- Dorien Kiers
- Prof. N. P. Riksen, Dept. of Internal Medicine 463, Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands, Tel.: +31 24 3618819, Fax: +31 24 3616519, E-mail:
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Wagenmakers MAEM, Roerink SHPP, Schreuder THA, Plantinga TS, Holewijn S, Thijssen DHJ, Smit JW, Rongen GA, Pereira AM, Wagenmakers AJM, Netea-Maier RT, Hermus ARMM. Vascular Health in Patients in Remission of Cushing's Syndrome Is Comparable With That in BMI-Matched Controls. J Clin Endocrinol Metab 2016; 101:4142-4150. [PMID: 27552540 DOI: 10.1210/jc.2016-1674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In active Cushing's syndrome (CS), patients suffer from endothelial dysfunction and premature atherosclerosis. However, it is uncertain to what extent vascular health recovers after long-term remission. This is highly relevant because this topic relates to future development of cardiovascular disease. OBJECTIVE The objective of the study was to investigate whether micro- and macrovascular health is impaired after long-term remission of CS in patients with no or adequately treated comorbidities. DESIGN AND SETTING This was a cross-sectional case-control study in two tertiary referral centers. PATIENTS AND MAIN OUTCOME MEASURES Sixty-three patients (remission of CS for ≥ 4 y) and 63 healthy, well-matched controls were compared. In group A (58 patients and 58 controls), serum biomarkers associated with endothelial dysfunction, intima media thickness, pulse wave velocity, and pulse wave analysis were studied. In group B (14 patients and 14 controls), endothelium-dependent and -independent vasodilatation was studied in conduit arteries (flow mediated dilation of the brachial artery) and forearm skeletal muscle resistance arteries (vasodilator response to intraarterial acetylcholine, sodium-nitroprusside, and NG-monomethyl-L-arginine using venous occlusion plethysmography). RESULTS There were no significant differences between the outcome measures of vascular health of patients and controls in groups A and B. CONCLUSION The vascular health of patients in long-term remission of CS seems to be comparable with that of healthy gender-, age-, and body mass index-matched controls, provided that the patients have no, or adequately controlled, comorbidities. Therefore, the effects of hypercortisolism per se on the vasculature may be reversible. This accentuates the need for the stringent treatment of metabolic comorbidities in these patients.
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Affiliation(s)
- M A E M Wagenmakers
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - S H P P Roerink
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - T H A Schreuder
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - T S Plantinga
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - S Holewijn
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - D H J Thijssen
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - J W Smit
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - G A Rongen
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - A M Pereira
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - A J M Wagenmakers
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - R T Netea-Maier
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - A R M M Hermus
- Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
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Rongen GA, Van Ingen I, Jansen TL. Vascular Consequences Of Interruption Of Tnf-Inhibitor Therapy In Patients With Rheumatoid Arthritis. Clin Ther 2016; 38:e8. [PMID: 27673675 DOI: 10.1016/j.clinthera.2016.07.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- G A Rongen
- Department of Internal Medicine/Pharmacology and Toxicology, Nijmegen, the Netherlands
| | - I Van Ingen
- Department of Rheumatology Radboudumc, Nijmegen, the Netherlands
| | - T L Jansen
- Department of Rheumatology, VieCuri MC, Venlo & Scientific IQ HealthCare Radboudumc, Nijmegen, the Netherlands
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van den Berg TNAD, van Swieten HA, Vos JC, Verweij V, Wouterse AC, Deinum J, Morshuis WJ, Rongen GA, Riksen NP. Eplerenone does not limit ischemia-reperfusion injury in human myocardial tissue. Int J Cardiol 2016; 216:110-3. [PMID: 27149239 DOI: 10.1016/j.ijcard.2016.04.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/16/2016] [Indexed: 12/11/2022]
Affiliation(s)
- T N A Daniëlle van den Berg
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands; Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - H A van Swieten
- Department of Cardiothoracic Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - J C Vos
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - V Verweij
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - A C Wouterse
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - J Deinum
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - W J Morshuis
- Department of Cardiothoracic Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - G A Rongen
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands; Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - N P Riksen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands.
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Koeneman BJ, de Nijs T, Rongen GA, Ketelaars R, Bonenkamp HJ, Koning GG, Schultze Kool LJ. Digital Ischemia in a Young Woman after Minor Wrist Trauma-A Rare Diagnosis and an Innovative Multidisciplinary Treatment. J Vasc Interv Radiol 2016; 27:608-11. [PMID: 27013009 DOI: 10.1016/j.jvir.2015.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Bouke J Koeneman
- Department of Internal Medicine Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
| | - Tjerk de Nijs
- Department of Internal Medicine Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
| | - Rein Ketelaars
- Department of Anesthesiology, Pain and Palliative Medicine Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
| | - Han J Bonenkamp
- Department of Surgery Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
| | - Giel G Koning
- Department of Surgery Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
| | - Leo J Schultze Kool
- Interventional Radiology Radboudumc Geert Grooteplein 8 Nijmegen 6525GA, The Netherlands
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El Messaoudi S, Russel FG, Colbers A, Bandell CCJG, van den Broek PHH, Burger DM, Rongen GA, Riksen NP. The effect of dipyridamole on the pharmacokinetics of metformin: a randomized crossover study in healthy volunteers. Eur J Clin Pharmacol 2016; 72:725-30. [PMID: 26979520 PMCID: PMC4869751 DOI: 10.1007/s00228-016-2039-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/29/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Concomitant treatment with the glucose-lowering drug metformin and the platelet aggregation inhibitor dipyridamole often occurs in patients with type 2 diabetes mellitus who have suffered a cerebrovascular event. The gastrointestinal uptake of metformin is mediated by the human equilibrative nucleoside transporter 4 (ENT4), which is inhibited by dipyridamole in preclinical studies. We hypothesized that dipyridamole lowers the plasma exposure to metformin. METHODS Eighteen healthy volunteers (mean age 23 years; 9 male) were randomized in an open-label crossover study. Subjects were allocated to treatment with metformin 500 mg twice daily in combination with dipyridamole slow-release 200 mg twice daily or to metformin alone for 4 days. After a washout period of 10 days, the volunteers were crossed over to the alternative treatment arm. Blood samples were collected during a 10-h period after intake of the last metformin dose. The primary endpoint was the area under the plasma concentration-time curve (AUC0-12h) and the maximum plasma metformin concentration (C max). RESULTS In healthy subjects, dipyridamole did not significantly affect Cmax nor AUC0-12h of metformin under steady-state conditions. CONCLUSIONS Previous in vitro studies report that dipyridamole inhibits the ENT4 transporter that mediates gastrointestinal uptake of metformin. In contrast, co-administration of dipyridamole at therapeutic dosages to healthy volunteers does not have a clinically relevant effect on metformin plasma steady-state exposure. This observation is reassuring for patients who are treated with this combination of drugs.
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Affiliation(s)
- S El Messaoudi
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F G Russel
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Colbers
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C C J G Bandell
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P H H van den Broek
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D M Burger
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G A Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine 463, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - N P Riksen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Internal Medicine 463, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Thijs AMJ, Tack CJ, van der Graaf WTA, Rongen GA, van Herpen CML. The early effect of sunitinib on insulin clearance in patients with metastatic renal cell carcinoma. Br J Clin Pharmacol 2016; 81:768-72. [PMID: 26447463 DOI: 10.1111/bcp.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022] Open
Abstract
AIMS In patients with diabetes treated with sunitinib symptomatic hypoglycaemia has been reported. To explore the mechanism of this adverse effect we performed a prospective study to investigate the effect of sunitinib on insulin concentration, insulin clearance and insulin sensitivity. METHODS We studied the early effects of sunitinib on insulin sensitivity and insulin clearance with a hyperinsulinaemic euglycaemic clamp (insulin infusion rate 60 mU m−2 min−1; steady-state 90–120 min) in patients with renal cell carcinoma before and 1 week after the start of sunitinib 50 mg day−1. Insulin sensitivity index (SI) was defined as steady-state glucose disposal divided by the steady-state plasma insulin. RESULTS Ten patients (one with diabetes, treated with metformin) were included in the study protocol. Steady-state insulin concentrations during the clamp increased after 1 week of sunitinib (from 128.9 ± 9.0 mU l−1 to 170.8 ± 12.8 mU l−1, P < 0.05; 95% CI on difference − 64.3, −19.6). The calculated insulin sensitivity index decreased from 0.22 ± 0.04 before to 0.18 ± 0.02 μmol kg−1 min−1 per mU l−1 insulin (P < 0.05; 95% CI on difference 0.07, 0.08). As the insulin infusion rate was similar for both clamps, the increased steady-state insulin concentration indicates reduced insulin clearance. CONCLUSION Sunitinib affects insulin clearance which could possibly lead to overexposure to insulin in patients using insulin or insulin-secretion stimulating agents.
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Affiliation(s)
- Anna Maria J Thijs
- Department of Pharmacology-Toxicology, Radboudumc, Nijmegen.,Department of Medical Oncology, Radboudumc, Nijmegen
| | - Cees J Tack
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboudumc, Nijmegen.,The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
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El Messaoudi S, Wouters CW, van Swieten HA, Pickkers P, Noyez L, Kievit PC, Abbink EJ, Rasing-Hoogveld A, Bouw TP, Peters JG, Coenen MJH, Donders ART, Riksen NP, Rongen GA. Effect of dipyridamole on myocardial reperfusion injury: A double-blind randomized controlled trial in patients undergoing elective coronary artery bypass surgery. Clin Pharmacol Ther 2015; 99:381-9. [PMID: 25773594 DOI: 10.1002/cpt.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/02/2015] [Indexed: 11/09/2022]
Abstract
Dipyridamole reduces reperfusion-injury in preclinical trials and may be beneficial in patients undergoing coronary angioplasty, but its effect on patients undergoing coronary artery bypass grafting (CABG) is unknown. We hypothesized that dipyridamole limits myocardial reperfusion-injury in patients undergoing CABG. The trial design was a double-blind trial randomizing between pretreatment with dipyridamole or placebo. In all, 94 patients undergoing elective on-pump CABG were recruited between February 2010 and June 2012. The primary endpoint was plasma high-sensitive (hs-) troponin-I at 6, 12, and 24 hours after reperfusion. Secondary endpoints were the occurrence of bleeding, arrhythmias, need for inotropic support, and intensive care unit length of stay. Finally, 79 patients (33 dipyridamole) were included in the per-protocol analysis. Dipyridamole did not significantly affect postoperative hs-troponin-I (change in plasma hs-troponin I -3% [95% confidence interval -23% to 36%]; P > 0.1). Secondary endpoints did not differ between groups. Dipyridamole prior to CABG does not significantly reduce postoperative hs-troponin release.
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Affiliation(s)
- S El Messaoudi
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C W Wouters
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H A van Swieten
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L Noyez
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P C Kievit
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Rasing-Hoogveld
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - T P Bouw
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J G Peters
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M J H Coenen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A R T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N P Riksen
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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El Messaoudi S, Nederlof R, Zuurbier CJ, van Swieten HA, Pickkers P, Noyez L, Dieker HJ, Coenen MJ, Donders ART, Vos A, Rongen GA, Riksen NP. Effect of metformin pretreatment on myocardial injury during coronary artery bypass surgery in patients without diabetes (MetCAB): a double-blind, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3:615-23. [PMID: 26179504 DOI: 10.1016/s2213-8587(15)00121-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND During coronary artery bypass graft (CABG) surgery, ischaemia and reperfusion damage myocardial tissue, and increased postoperative plasma troponin concentration is associated with a worse outcome. We investigated whether metformin pretreatment limits cardiac injury, assessed by troponin concentrations, during CABG surgery in patients without diabetes. METHODS We did a placebo-controlled, double-blind, single-centre study in an academic hospital in Nijmegen (Netherlands) in adult patients without diabetes undergoing an elective on-pump CABG procedure. We randomly assigned patients (1:1) in blocks of ten via a computer-generated randomisation sequence to either metformin hydrochloride (500 mg three times per day) or placebo (three times per day) for 3 days before surgery. The last dose was given roughly 3 h before surgery. Patients, investigators, trial staff, and the statistician were all masked to treatment allocation. The primary endpoint was the plasma concentration of high-sensitive troponin I at 6, 12, and 24 h postreperfusion after surgery, analysed in the per-protocol population with a mixed-model analysis using all these timepoints. Secondary endpoints included the occurrence of clinically relevant arrhythmias within 24 hours after reperfusion, the need for inotropic support, time to detubation, duration of stay in the intensive-care unit, and postoperative use of insulin. This study is registered with ClinicalTrials.gov, number NCT01438723. FINDINGS Between Nov 8, 2011, and Nov 22, 2013, we randomly assigned 111 patients to treatment (57 to metformin and 54 to placebo). Five patients dropped out from the metformin group, and six from the placebo group. 52 patients in the metformin group and 48 patients in the placebo group were included in the per-protocol analysis. Geometric mean high-sensitivity troponin I increased from 0 μg/L to 3·67 μg/L (95% CI 3·06-4·41) with metformin and to 3·32 μg/L (2·75-4·01) with placebo at 6 h after reperfusion; 2·84 μg/L (2·37-3·41) and 2·45 μg/L (2·02-2·96), respectively, at 12 h; and to 1·77 μg/L (1·47-2·12) and 1·60 μg/L (1·32-1·94) at 24 h. The concentrations did not differ significantly between the groups (difference 12·3% for all timepoints [95% CI -12·4 to 44·1] p=0·35). Occurrence of arrhythmias did not differ between groups (three [5·8%] of 52 patients who received metformin vs three [6·3%] of 48 patients who received placebo; p=1·00). There was no difference between groups in the need for inotropic support, time to detubation, duration of stay in the intensive-care unit, or postoperative use of insulin. No patients died within 30 days after surgery. Occurrence of gastrointestinal discomfort (mostly diarrhoea) was significantly higher with metformin than with placebo (11 [21·2%] of 52 vs two [4·2%] of 48 patients; p=0·01). INTERPRETATION Short-term metformin pretreatment, although safe, does not seem to be an effective strategy to reduce periprocedural myocardial injury in patients without diabetes undergoing CABG surgery. FUNDING Netherlands Organisation for Health Research and Development and Netherlands Heart Foundation.
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Affiliation(s)
- Saloua El Messaoudi
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rianne Nederlof
- Laboratory of Experimental Intensive Care and Anesthesiology, Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
| | - Coert J Zuurbier
- Laboratory of Experimental Intensive Care and Anesthesiology, Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
| | - Henry A van Swieten
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc Noyez
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hendrik-Jan Dieker
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke J Coenen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Annemieke Vos
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerard A Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niels P Riksen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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van Poppel PCM, Breedveld P, Abbink EJ, Roelofs H, van Heerde W, Smits P, Lin W, Tan AH, Russel FG, Donders R, Tack CJ, Rongen GA. Salvia Miltiorrhiza Root Water-Extract (Danshen) Has No Beneficial Effect on Cardiovascular Risk Factors. A Randomized Double-Blind Cross-Over Trial. PLoS One 2015; 10:e0128695. [PMID: 26192328 PMCID: PMC4508048 DOI: 10.1371/journal.pone.0128695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/22/2015] [Indexed: 01/06/2023] Open
Abstract
Purpose Danshen is the dried root extract of the plant Salvia Miltiorrhiza and it is used as traditional Chinese medicinal herbal product to prevent and treat atherosclerosis. However, its efficacy has not been thoroughly investigated. This study evaluates the effect of Danshen on hyperlipidemia and hypertension, two well known risk factors for the development of atherosclerosis. Methods This was a randomized, placebo-controlled, double-blind crossover study performed at a tertiary referral center. Participants were recruited by newspaper advertisement and randomized to treatment with Danshen (water-extract of the Salvia Miltiorrhiza root) or placebo for 4 consecutive weeks. There was a wash out period of 4 weeks. Of the 20 analysed participants, 11 received placebo first. Inclusion criteria were: age 40-70 years, hyperlipidemia and hypertension. At the end of each treatment period, plasma lipids were determined (primary outcome), 24 hours ambulant blood pressure measurement (ABPM) was performed, and vasodilator endothelial function was assessed in the forearm. Results LDL cholesterol levels were 3.82±0.14 mmol/l after Danshen and 3.52±0.16 mmol/l after placebo treatment (mean±SE; p<0.05 for treatment effect corrected for baseline). Danshen treatment had no effect on blood pressure (ABPM 138/84 after Danshen and 136/87 after placebo treatment). These results were further substantiated by the observation that Danshen had neither an effect on endothelial function nor on markers of inflammation, oxidative stress, glucose metabolism, hemostasis and blood viscosity. Conclusion Four weeks of treatment with Danshen (water-extract) slightly increased LDL-cholesterol without affecting a wide variety of other risk markers. These observations do not support the use of Danshen to prevent or treat atherosclerosis. Trial Registration ClinicalTrials.gov NCT01563770
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Affiliation(s)
- Pleun C. M. van Poppel
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Pauline Breedveld
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Evertine J. Abbink
- Clinical Research Centre Nijmegen, Radboud university medical center, Nijmegen, The Netherlands
| | - Hennie Roelofs
- Department of Gastro-Enterology, Radboud university medical center, Nijmegen, The Netherlands
| | - Waander van Heerde
- Department of Clinical Chemistry, Radboud university medical center, Nijmegen, The Netherlands
| | - Paul Smits
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Wenzhi Lin
- Medical Center Balans, The Hague, The Netherlands
| | - Aaitje H. Tan
- Practice for acupuncture and member of the Dutch Association of Acupuncture Medicine, Amsterdam, The Netherlands
| | - Frans G. Russel
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Cees J. Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Gerard A. Rongen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail:
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Rongen GA, Wever KE. Cardiovascular pharmacotherapy: Innovation stuck in translation. Eur J Pharmacol 2015; 759:200-4. [PMID: 25814253 DOI: 10.1016/j.ejphar.2015.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/07/2015] [Accepted: 03/12/2015] [Indexed: 12/25/2022]
Abstract
Systematic reviews of animal studies have revealed serious limitations in internal and external validity strongly affecting the reliability of this research. In addition inter-species differences are likely to further limit the predictive value of animal research for the efficacy and tolerability of new drugs in humans. Important changes in the research process are needed to allow efficient translation of preclinical discoveries to the clinic, including improvements in the laboratory and publication practices involving animal research and early incorporation of human proof-of-concept studies to optimize the interpretation of animal data for its predictive value for humans and the design of clinical trials.
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Affiliation(s)
- Gerard A Rongen
- Department of Pharmacology-Toxicology and Internal Medicine, Radboud university medical center, P.O. box 9101, Internal post address: 137, 6500 HB Nijmegen, The Netherlands.
| | - Kimberley E Wever
- SYstematic Review Centre for Laboratory animal Experimentation, Radboud university medical center, Nijmegen, The Netherlands
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van Lent M, Rongen GA, Out HJ. Shortcomings of protocols of drug trials in relation to sponsorship as identified by Research Ethics Committees: analysis of comments raised during ethical review. BMC Med Ethics 2014; 15:83. [PMID: 25490963 PMCID: PMC4269968 DOI: 10.1186/1472-6939-15-83] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Submission of study protocols to research ethics committees (RECs) constitutes one of the earliest stages at which planned trials are documented in detail. Previous studies have investigated the amendments requested from researchers by RECs, but the type of issues raised during REC review have not been compared by sponsor type. The objective of this study was to identify recurring shortcomings in protocols of drug trials based on REC comments and to assess whether these were more common among industry-sponsored or non-industry trials. METHODS Retrospective analysis of 226 protocols of drug trials approved in 2010-2011 by three RECs affiliated to academic medical centres in The Netherlands. For each protocol, information on sponsorship, number of participating centres, participating countries, study phase, registration status of the study drug, and type and number of subjects was retrieved. REC comments were extracted from decision letters sent to investigators after review and were classified using a predefined checklist that was based on legislation and guidelines on clinical drug research and previous literature. RESULTS Most protocols received comments regarding participant information and consent forms (n = 182, 80.5%), methodology and statistical analyses (n = 160, 70.8%), and supporting documentation, including trial agreements and certificates of insurance (n = 154, 68.1%). Of the submitted protocols, 122 (54.0%) were non-industry and 104 (46.0%) were industry-sponsored trials. Non-industry trials more often received comments on subject selection (n = 44, 36.1%) than industry-sponsored trials (n = 18, 17.3%; RR, 1.58; 95% CI, 1.01 to 2.47), and on methodology and statistical analyses (n = 95, 77.9% versus n = 65, 62.5%, respectively; RR, 1.18; 95% CI, 1.01 to 1.37). Non-industry trials less often received comments on supporting documentation (n = 72, 59.0%) than industry-sponsored trials (n = 82, 78.8%; RR, 0.83; 95% CI, 0.72 to 0.95). CONCLUSIONS RECs identified important ethical and methodological shortcomings in protocols of both industry-sponsored and non-industry drug trials. Investigators, especially of non-industry trials, should better prepare their research protocols in order to facilitate the ethical review process.
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Affiliation(s)
- Marlies van Lent
- />Clinical Research Centre Nijmegen, Department of Pharmacology – Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A Rongen
- />Department of Pharmacology – Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- />Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk J Out
- />Clinical Research Centre Nijmegen, Department of Pharmacology – Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- />Teva Pharmaceuticals, Amsterdam, The Netherlands
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van den Berg TNA, Deinum J, Bilos A, Donders ART, Rongen GA, Riksen NP. The effect of eplerenone on adenosine formation in humans in vivo: a double-blinded randomised controlled study. PLoS One 2014; 9:e111248. [PMID: 25356826 PMCID: PMC4214740 DOI: 10.1371/journal.pone.0111248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background It has been suggested that mineralocorticoid receptor antagonists have direct cardioprotective properties, because these drugs reduce mortality in patients with heart failure. In murine models of myocardial infarction, mineralocorticoid receptor antagonists reduce infarct size. Using gene deletion and pharmacological approaches, it has been shown that extracellular formation of the endogenous nucleoside adenosine is crucial for this protective effect. We now aim to translate this finding to humans, by investigating the effects of the selective mineralocorticoid receptor antagonist eplerenone on the vasodilator effect of the adenosine uptake inhibitor dipyridamole, which is a well-validated surrogate marker for extracellular adenosine formation. Methods and Results In a randomised, double-blinded, placebo-controlled, cross-over study we measured the forearm blood flow response to the intrabrachial administration of dipyridamole in 14 healthy male subjects before and after treatment with placebo or eplerenone (50 mg bid for 8 days). The forearm blood flow during administration of dipyridamole (10, 30 and 100 µg·min−1·dl−1) was 1.63 (0.60), 2.13 (1.51) and 2.71 (1.32) ml·dl−1·min−1 during placebo use, versus 2.00 (1.45), 2.68 (1.87) and 3.22 (1.94) ml·dl−1·min−1 during eplerenone treatment (median (interquartile range); P = 0.51). Concomitant administration of the adenosine receptor antagonist caffeine attenuated dipyridamole-induced vasodilation to a similar extent in both groups. The forearm blood flow response to forearm ischemia, as a stimulus for increased formation of adenosine, was similar during both conditions. Conclusion In a dosage of 50 mg bid, eplerenone does not augment extracellular adenosine formation in healthy human subjects. Therefore, it is unlikely that an increased extracellular adenosine formation contributes to the cardioprotective effect of mineralocorticoid receptor antagonists. Trial Registration ClinicalTrials.gov, NCT01837108
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Affiliation(s)
- T. N. A. van den Berg
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert Bilos
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard A. Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels P. Riksen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
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El Messaoudi S, Schreuder TH, Kengen RD, Rongen GA, van den Broek PH, Thijssen DHJ, Riksen NP. Impact of metformin on endothelial ischemia-reperfusion injury in humans in vivo: a prospective randomized open, blinded-endpoint study. PLoS One 2014; 9:e96062. [PMID: 24755906 PMCID: PMC3996005 DOI: 10.1371/journal.pone.0096062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/01/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Large prospective studies in patients with type 2 diabetes mellitus have demonstrated that metformin treatment improves cardiovascular prognosis, independent of glycemic control. Administration of metformin potently limits infarct size in murine models of myocardial infarction. This study examined, for the first time in humans, whether metformin limits ischemia-reperfusion (IR) injury in vivo using a well-validated forearm model of endothelial IR-injury. METHODS Twenty-eight healthy volunteers (age 41±6 years, 10 male/16 female) were randomized between pretreatment with metformin (500 mg three times a day for 3 days) or no treatment in a Prospective Randomized Open Blinded Endpoint study. Brachial artery flow mediated dilation (FMD) was measured before and after 20 minutes of forearm ischemia and 20 minutes of reperfusion. FMD analysis was performed offline by investigators blinded for the treatment arm. RESULTS Baseline FMD did not differ between metformin pretreatment and no pretreatment (6.9±3.6% and 6.1±3.5%, respectively, p = 0.27, n = 26). FMD was significantly lower after forearm IR in both treatment arms (4.4±3.3% and 4.3±2.8%, respectively, P<0.001 in both conditions). A linear mixed model analysis revealed that metformin treatment did not prevent the decrease in FMD by IR. CONCLUSION A 3 day treatment with metformin in healthy, middle-aged subjects does not protect against endothelial IR-injury, measured with brachial artery FMD after forearm ischemia. Further studies are needed to clarify what mechanism underlies the cardiovascular benefit of metformin treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT01610401.
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Affiliation(s)
- Saloua El Messaoudi
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim H. Schreuder
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel D. Kengen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A. Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petra H. van den Broek
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H. J. Thijssen
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Niels P. Riksen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of General Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
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Wijeysundera HC, Parmar G, Rongen GA, Floras JS. Reflex systemic sympatho-neural response to brachial adenosine infusion in treated heart failure. Eur J Heart Fail 2014; 13:475-81. [DOI: 10.1093/eurjhf/hfr005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Harindra C. Wijeysundera
- Mount Sinai Hospital and University Health Network Division of Cardiology, Faculty of Medicine; University of Toronto; Toronto ON Canada
- Sunnybrook Health Sciences Centre Division of Cardiology, Faculty of Medicine; University of Toronto; Suite A209D, 2075 Bayview Avenue Toronto ON Canada M4N 3M5
| | - Gurpreet Parmar
- Mount Sinai Hospital and University Health Network Division of Cardiology, Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Gerard A. Rongen
- Department of Pharmacology-Toxicology and General Internal Medicine; Nijmegen Netherlands
| | - John S. Floras
- Mount Sinai Hospital and University Health Network Division of Cardiology, Faculty of Medicine; University of Toronto; Toronto ON Canada
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Affiliation(s)
- Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525GA, Netherlands.
| | - Saloua el Messaoudi
- Department of Pharmacology-Toxicology, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525GA, Netherlands
| | - Gerard A Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525GA, Netherlands
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van den Berg TNA, Rongen GA, Fröhlich GM, Deinum J, Hausenloy DJ, Riksen NP. The cardioprotective effects of mineralocorticoid receptor antagonists. Pharmacol Ther 2013; 142:72-87. [PMID: 24275323 DOI: 10.1016/j.pharmthera.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 01/14/2023]
Abstract
Despite state-of-the-art reperfusion therapy, morbidity and mortality remain significant in patients with an acute myocardial infarction. Therefore, novel strategies to limit myocardial ischemia-reperfusion injury are urgently needed. Mineralocorticoid receptor (MR) antagonists are attractive candidates for this purpose, since several clinical trials in patients with heart failure have reported a survival benefit with MR antagonist treatment. MRs are expressed by several cells of the cardiovascular system, including cardiomyocytes, cardiac fibroblasts, vascular smooth muscle cells, and endothelial cells. Experiments in animal models of myocardial infarction have demonstrated that acute administration of MR antagonists, either before ischemia or immediately at the moment of coronary reperfusion, limits infarct size. This action appears to be independent of the presence of aldosterone and cortisol, which are the endogenous ligands for the MR. The cardioprotective effect is mediated by a nongenomic intracellular signaling pathway, including adenosine receptor stimulation, and activation of several components of the Reperfusion Injury Salvage Kinase (RISK) pathway. In addition to limiting infarct size, MR antagonists can improve scar healing when administered shortly after reperfusion and can reduce cardiac remodeling post myocardial infarction. Clinical trials are currently being performed studying whether early administration of MR antagonists can indeed improve prognosis in patients with an acute myocardial infarction, independent of the presence of heart failure.
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Affiliation(s)
- T N A van den Berg
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Georg M Fröhlich
- The Hatter Cardiovascular Institute, University College London, United Kingdom
| | - Jaap Deinum
- Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, United Kingdom
| | - Niels P Riksen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
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Messaoudi SE, Vissers A, Thijssen D, Riksen NP, Rongen GA. The effect of remote ischemic preconditioning on exercise-induced plasma troponin I appearance in healthy volunteers. Int J Cardiol 2013; 168:1612-3. [DOI: 10.1016/j.ijcard.2013.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/18/2013] [Indexed: 11/29/2022]
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Thijs AM, van Herpen CM, Sweep FC, Geurts-Moespot A, Smits P, van der Graaf WT, Rongen GA. Role of Endogenous Vascular Endothelial Growth Factor in Endothelium-Dependent Vasodilation in Humans. Hypertension 2013; 61:1060-5. [DOI: 10.1161/hypertensionaha.111.00841] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Angiogenesis inhibitors have remarkably improved the outcome of patients with several types of cancer. Hypertension is the most reported side effect of angiogenesis inhibitors interfering with vascular endothelial growth factor signaling. In this study, we test the hypothesis that circulating vascular endothelial growth factor at physiological concentrations is essential to preserve normal endothelial control of vasomotor tone. In 7 healthy male volunteers, infusion of bevacizumab (monoclonal vascular endothelial growth factor antibody) into the brachial artery for 15 minutes (144 μg/dL forearm volume per minute) did not affect forearm vasodilator tone as measured with venous occlusion strain gauge plethysmography. In a separate group of 12 male volunteers, a similar bevacizumab infusion reduced the vasodilator response to 2 dosages of acetylcholine from (mean±SE) 440±157% and 926±252% to 169±40% and 612±154% (
P
<0.05). Finally, in a third group of 12 volunteers, bevacizumab did not alter the percentage increase in forearm blood flow during infusion of sodium nitroprusside at dosages equipotent to acetylcholine. Bevacizumab acutely and specifically reduced endothelium-mediated vasodilation at local concentrations that resemble plasma concentrations after systemic exposure to bevacizumab. This observation suggests a physiological role for vascular endothelial growth factor in maintaining normal endothelial control of vasomotor tone. The role of the endothelium in the mechanism of bevacizumab-induced hypertension deserves further exploration.
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Affiliation(s)
- Anna M.J. Thijs
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Carla M.L. van Herpen
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Fred C.G.J. Sweep
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Anneke Geurts-Moespot
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Paul Smits
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Winette T.A. van der Graaf
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gerard A. Rongen
- From the Department of Pharmacology-Toxicology (A.M.J.T., P.S., G.A.R.), Department of Medical Oncology (A.M.J.T., C.M.L.v.H., W.T.A.v.d.G.), Department of Laboratory Medicine (F.C.G.J.S., A.G.-M.), and Department of General Internal Medicine (P.S., G.A.R.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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van den Munckhof I, Riksen N, Seeger JPH, Schreuder TH, Borm GF, Eijsvogels TMH, Hopman MTE, Rongen GA, Thijssen DHJ. Aging attenuates the protective effect of ischemic preconditioning against endothelial ischemia-reperfusion injury in humans. Am J Physiol Heart Circ Physiol 2013; 304:H1727-32. [PMID: 23604707 DOI: 10.1152/ajpheart.00054.2013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Reperfusion is mandatory after ischemia but also triggers ischemia-reperfusion (I/R) injury. Ischemic preconditioning (IPC) can limit endothelial I/R injury. Nonetheless, translation of IPC to the clinical arena is often disappointing. Since application of IPC typically relates to older patients, efficacy of IPC may be attenuated with aging. Our objective was to examine the impact of advanced age on the ability of IPC to protect against endothelial dysfunction due to I/R injury. We included 15 healthy young (20-25 yr) and 15 older (68-77 yr) men. We examined brachial artery endothelial function using flow-mediated dilation (FMD) before and after arm I/R (induced by inflation of an upper-arm blood pressure cuff for 20 min and 15 min of reperfusion). In a randomized order, I/R was preceded by IPC or a control intervention consisting of three cycles of 5 min upper-arm cuff inflation to 220 or 20 mmHg, respectively. As a result, in young men, FMD decreased significantly after I/R (6.4 ± 2.7 to 4.4 ± 2.5%). This decrease was not present when I/R was preceded by IPC (5.9 ± 2.3 to 5.6 ± 2.5%). IPC-induced protection appeared to be significantly reduced in the elderly patients (P = 0.04). Although FMD decreased after I/R in older men (3.5 ± 1.7 to 2.5 ± 1.0%), IPC could not prevent this (3.7 ± 2.1 to 2.2 ± 1.1%). In conclusion, this study is the first to observe in humans in vivo that older age is associated with an abolished effect of IPC to protect against endothelial dysfunction after I/R in the brachial artery. This provides a possible explanation for the problematic translation of strategies that reduce I/R injury from preclinical work to the clinical arena.
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Affiliation(s)
- Inge van den Munckhof
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Wever KE, Masereeuw R, Wagener FA, Verweij VG, Peters JG, Pertijs JC, Van der Vliet JA, Warlé MC, Rongen GA. Humoral signalling compounds in remote ischaemic preconditioning of the kidney, a role for the opioid receptor. Nephrol Dial Transplant 2013; 28:1721-32. [DOI: 10.1093/ndt/gfs601] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rongen GA. [Clopidogrel plus acetylsalicylic acid: a deadly combination]. Ned Tijdschr Geneeskd 2013; 157:A6221. [PMID: 23777967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the recently published SPS3 trial, clopidogrel plus aspirin increased mortality compared with aspirin alone in patients with lacunar cerebral infarcts. A detailed review of currently available trial data on this dual-antiplatelet strategy, having taken the between-trial variation in mortality in the various control groups into account, indicates lethal toxicity which also occurs in patients with coronary atherosclerosis. The recently observed benefit of an alternative P2Y12 receptor antagonist (ticragelor) on survival as compared with clopidogrel suggests that the toxicity of the clopidogrel/aspirin combination likely results from an 'off-target' effect. The exact nature of this 'off-target' effect is currently unknown. The lack of a survival benefit in combination with the frequent occurrence of serious bleeding complications requires the cessation of the use of clopidogrel in combination with aspirin. The question whether clopidogrel should be replaced by an alternative P2Y12 receptor antagonist needs to be answered by future trials.
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Affiliation(s)
- Gerard A Rongen
- UMC St Radboud, afd. Farmacologie-Toxicologie, Nijmegen, the Netherlands.
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Engbersen R, Riksen NP, Mol MJ, Bravenboer B, Boerman OC, Meijer P, Oyen WJG, Tack C, Rongen GA, Smits P. Improved resistance to ischemia and reperfusion, but impaired protection by ischemic preconditioning in patients with type 1 diabetes mellitus: a pilot study. Cardiovasc Diabetol 2012; 11:124. [PMID: 23051145 PMCID: PMC3504536 DOI: 10.1186/1475-2840-11-124] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 10/09/2012] [Indexed: 02/08/2023] Open
Abstract
Background In patients with type 1 diabetes mellitus (T1DM), cardiovascular events are more common, and the outcome following a myocardial infarction is worse than in nondiabetic subjects. Ischemic or pharmacological preconditioning are powerful interventions to reduce ischemia reperfusion (IR)-injury. However, animal studies have shown that the presence of T1DM can limit these protective effects. Therefore, we aimed to study the protective effect of ischemic preconditioning in patients with T1DM, and to explore the role of plasma insulin and glucose on this effect. Methods 99mTechnetium-annexin A5 scintigraphy was used to detect IR-injury. IR-injury was induced by unilateral forearm ischemic exercise. At reperfusion, Tc-annexin A5 was administered, and IR-injury was expressed as the percentage difference in radioactivity in the thenar muscle between the experimental and control arm 4 hours after reperfusion. 15 patients with T1DM were compared to 21 nondiabetic controls. The patients were studied twice, with or without ischemic preconditioning (10 minutes of forearm ischemia and reperfusion). Patients were studied in either normoglycemic hyperinsulinemic conditions (n = 8) or during hyperglycemic normoinsulinemia (n = 7). The controls were studied once either with (n = 8) or without (n = 13) ischemic preconditioning. Results Patients with diabetes were less vulnerable to IR-injury than nondiabetic healthy controls (12.8 ± 2.4 and 11.0 ± 5.1% versus 27.5 ± 4.5% in controls; p < 0.05). The efficacy of ischemic preconditioning to reduce IR-injury, however, was lower in the patients and was even completely abolished during hyperglycemia. Conclusions Patients with T1DM are more tolerant to forearm IR than healthy controls in our experimental model. The efficacy of ischemic preconditioning to limit IR-injury, however, is reduced by acute hyperglycemia. Trial Registration The study is registered at www.clinicaltrials.gov (NCT00184821)
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Affiliation(s)
- Richard Engbersen
- Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Centre, P,O, Box 9101, Nijmegen, 6500 HB, The Netherlands
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Abstract
Adenosine receptor stimulation has negative inotropic and dromotropic actions, reduces cardiac ischemia-reperfusion injury and remodeling, and prevents cardiac arrhythmias. In the vasculature, adenosine modulates vascular tone, reduces infiltration of inflammatory cells and generation of foam cells, and may prevent the development of atherosclerosis as a result. Modulation of insulin sensitivity may further add to the anti-atherosclerotic properties of adenosine signaling. In the kidney, adenosine plays an important role in tubuloglomerular feedback and modulates tubular sodium reabsorption. The challenge is to take advantage of the beneficial actions of adenosine signaling while preventing its potential adverse effects, such as salt retention and sympathoexcitation. Drugs that interfere with adenosine formation and elimination or drugs that allosterically enhance specific adenosine receptors seem to be most promising to meet this challenge.
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Affiliation(s)
- Niels P Riksen
- Department of Pharmacology-Toxicology 149 and Internal Medicine 463, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Thijs AM, van Herpen CM, van der Graaf WT, Smits P, Rongen GA. Abstract 1693: Bevacizumab acutely decreases endothelium dependent vasodilation in healthy volunteers. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Angiogenesis inhibitors have remarkably improved the outcome of patients with several types of cancer. One of the most reported side effects of angiogenesis inhibitors is hypertension. In patients treated with bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), hypertension has an overall incidence up to 32%. Understanding the pathogenesis of this side effect is essential for optimal treatment with this class of drugs. Microvascular endothelial dysfunction is involved in the pathogenesis of hypertension. Our hypothesis is that bevacizumab (BVZ) induced hypertension is caused by an acute reduction of endothelium-mediated vasodilation. Methods: BVZ was infused intra-arterially to separate direct local effects of VEGF inhibition from systemic actions, such as hypertension, that could indirectly interfere with endothelial function. At first, in seven volunteers the acute vasomotor effect of BVZ was studied. During 15 minutes BVZ 144 μg/dl forearm volume/min was infused in the brachial artery of the non-dominant arm while assessing forearm blood flow (FBF) with venous strain gauge plethysmography. During BVZ infusion venous blood was collected from both arms to measure local and systemic concentrations of BVZ. Subsequently the acute vasodilator response to intra-arterial acetylcholine (Ach, endothelium-dependent vasodilator) alone and during simultaneous infusion of BVZ was studied, in another group of 12 volunteers. Finally, the effect of BVZ on the response to an endothelium-independent vasodilator nitroprusside (SNP) was studied in a similar experimental set up, in a third group of 12 volunteers. Results: In the experimental arm during infusion BVZ reached a concentration of 135±10,7μg/ml (± SD; n=8), resembling systemic exposure to BVZ in patients treated with 5mg BVZ i.v./kg. BVZ concentration in the control arm was 6,7±1,1 μg/ml (n=10). Intra-arterial BVZ did not directly alter forearm vascular tone. Infusion of BVZ significantly reduced the percentage increase in forearm blood flow during infusion of two dosages of acetylcholine from (mean±SE) 440±157 and 926±252 to 169±154 and 612±40 (p<0,05, ANOVA for repeated measures on log-transformed data). In the absence of BVZ, the vasodilator response to SNP equaled the response to ACh. BVZ did not alter the percentage increase in forearm blood flow during infusion of SNP (n=12). Conclusion: Although BVZ did not alter baseline forearm vascular tone, it acutely and specifially reduced endothelium-mediated vasodilation. Although this observation suggests a minor role for the muscle vascular bed, a similar acute effect in other organs such as the kidney could very well be involved in the pathogenesis of BVZ-induced hypertension.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1693. doi:1538-7445.AM2012-1693
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Affiliation(s)
- Anna M. Thijs
- 1Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | | | - Paul Smits
- 1Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Gerard A. Rongen
- 1Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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Wouters CW, Meijer P, Janssen CIF, Frederix GWJ, Oyen WJ, Boerman OC, Smits P, Rongen GA. Atorvastatin does not affect ischaemia-induced phosphatidylserine exposition in humans in-vivo. J Atheroscler Thromb 2011; 19:285-91. [PMID: 22146238 DOI: 10.5551/jat.10983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Statins can induce pharmacologic preconditioning and thereby reduce infarct size. Cellular phosphatidylserine (PS) exposition occurs in the course of ischaemia and reperfusion and has been associated with injury. In this experiment we studied the effect of atorvastatin on PS exposition after a standardised ischaemia and reperfusion challenge. METHODS In a double-blind randomised cross-over trial 30 healthy volunteers were allocated to 3 day treatment with atorvastatin (80 mg/day) and placebo (n = 24), or placebo treatment twice (n = 6). At the end of each treatment period, volunteers underwent 10 minutes of forearm ischaemic exercise. At reperfusion radiolabeled annexin A5 was administered intravenously and Gamma camera imaging of both hands was performed 1 and 4 hours after reperfusion. RESULTS Annexin A5 targeting was not different between atorvastatin treatment (26.1 ± 9.8% and 24.0 ± 9.5% respectively at 1 and 4 hours after reperfusion) and placebo treatment (25.6 ± 11.0% and 24.5 ± 10.7%) (p = 0.99). Our time control experiment did not reveal a carry-over effect. CONCLUSIONS Our results show that treatment with atorvastatin 80 mg does not reduce forearm PS exposition after ischaemic exercise. This suggests that the role of PS exposure in the prevention of ischemia and reperfusion injury by short term treatment with atorvastatin is limited.
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Affiliation(s)
- Constantijn W Wouters
- Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Centre, The Netherlands
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Abstract
PURPOSE OF REVIEW In patients with type 2 diabetes mellitus, treatment with metformin is associated with a lower cardiovascular morbidity and mortality, compared with alternative glucose-lowering drugs. It has been suggested that metformin might exert direct protective effects on the heart. RECENT FINDINGS This review appraises recent experimental animal studies on the effect of metformin on myocardial ischaemia-reperfusion injury and remodeling. In murine models of myocardial infarction, the administration of metformin potently limits infarct size. Activation of adenosine monophosphate-activated protein kinase, increased formation of adenosine, and the prevention of opening of the mitochondrial permeability transition pore at reperfusion all contribute to this cardioprotective effect. In addition, metformin therapy attenuates postinfarction cardiac remodeling. There is evidence that activation of adenosine monophosphate-activated protein kinase and endothelial nitric oxide synthase, and a reduced collagen expression are crucial for this effect. SUMMARY The finding that metformin limits myocardial infarct size and remodeling in animal models of myocardial infarction suggests that patients suffering from myocardial ischaemia could benefit from treatment with metformin, even when these patients do not have diabetes. Currently, several clinical trials are being performed to test this hypothesis.
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Affiliation(s)
- Saloua El Messaoudi
- Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Groothuis JT, Rongen GA, Geurts AC, Smits P, Hopman MT. Effect of different sympathetic stimuli-autonomic dysreflexia and head-up tilt-on leg vascular resistance in spinal cord injury. Arch Phys Med Rehabil 2011; 91:1930-5. [PMID: 21112436 DOI: 10.1016/j.apmr.2010.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/19/2010] [Accepted: 09/01/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effect of different sympathetic stimuli, that is, exaggerated sympathetic activity and orthostatic challenges, on the increase in leg vascular resistance in persons with spinal cord injury (SCI) without and controls with supraspinal sympathetic control. DESIGN Case-control intervention study. SETTING Physiology research laboratory. PARTICIPANTS Persons with SCI (N=9; motor and sensory complete spinal cord lesion above the sixth thoracic spinal segment) and able-bodied controls (N=9). INTERVENTIONS In persons with SCI, exaggerated sympathetic activity was evoked by autonomic dysreflexia, and in controls, by using a cold pressor test (CPT). A 30° head-up tilt (HUT) was performed in both groups. MAIN OUTCOME MEASURE Leg blood flow was measured by using venous occlusion plethysmography during the different sympathetic stimuli. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. RESULTS In persons with SCI, leg vascular resistance significantly increased during autonomic dysreflexia and 30° HUT (25±20 and 24±13 arbitrary units [AU], respectively), with no difference (P=.87) between stimuli. In controls, leg vascular resistance significantly increased during CPT and 30° HUT (15±13 and 29±12AU, respectively) with no difference (P=.03) between stimuli. There were no differences (P=.22) in increase in leg vascular resistance during the different sympathetic stimuli between persons with SCI and controls. CONCLUSIONS The increase in leg vascular resistance during autonomic dysreflexia in persons with SCI is not different from that during 30° HUT, which might be caused by a limited vasoconstrictor reserve. Despite the lack of supraspinal sympathetic control in persons with SCI, the increase in leg vascular resistance during exaggerated sympathetic activity was not different from controls.
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Affiliation(s)
- Jan T Groothuis
- Department of Physiology, Radboud University Nijmegen Medical Centre, The Netherlands
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