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Scullion KM, MacIntyre IM, Sloan-Dennison S, Clark B, Fineran P, Mair J, Creasey D, Rathmell C, Faulds K, Graham D, Webb DJ, Dear JW. Cytokeratin-18 is a sensitive biomarker of alanine transaminase increase in a placebo-controlled, randomized, crossover trial of therapeutic paracetamol dosing (PATH-BP biomarker Sub-study). Toxicol Sci 2024:kfae031. [PMID: 38521541 DOI: 10.1093/toxsci/kfae031] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
Drug-induced liver injury (DILI) is a challenge in clinical medicine and drug development. Highly sensitive novel biomarkers have been identified for detecting DILI following a paracetamol overdose. The study objective was to evaluate biomarker performance in a 14-day trial of therapeutic dose paracetamol. The PATH-BP trial was a double-blind, placebo-controlled, crossover study. Individuals (n = 110) were randomized to receive 1 g paracetamol 4×daily or matched placebo for 2 weeks followed by a 2-week washout before crossing over to the alternate treatment. Blood was collected on days 0 (baseline), 4, 7 and 14 in both arms. Alanine transaminase (ALT) activity was measured in all patients. MicroRNA-122 (miR-122), cytokeratin-18 (K18) and glutamate dehydrogenase (GLDH) were measured in patients who had an elevated ALT on paracetamol treatment (≥50% from baseline). ALT increased in 49 individuals (45%). All 3 biomarkers were increased at the time of peak ALT (K18 paracetamol arm: 18.9 ± 9.7 ng/mL, placebo arm: 11.1 ± 5.4 ng/mL, ROC-AUC = 0.80, 95%CI 0.71-0.89; miR-122: 15.1 ± 12.9fM V 4.9 ± 4.7fM, ROC-AUC = 0.83, 0.75-0.91; and GLDH : 24.6 ± 31.1U/L V 12.0 ± 11.8U/L, ROC-AUC = 0.66,0.49-0.83). All biomarkers were correlated with ALT (K18 r = 0.68, miR-122 r = 0.67, GLDH r = 0.60). To assess sensitivity, biomarker performance was analyzed on the visit preceding peak ALT (mean 3 days earlier). K18 identified the subsequent ALT increase (K18 ROC-AUC = 0.70, 0.59-0.80; miR-122 ROC-AUC = 0.60,0.49-0.72, ALT ROC-AUC = 0.59,0.48-0.70; GLDH ROC-AUC = 0.70,0.50-0.90). Variability was lowest for ALT and K18. In conclusion, K18 was more sensitive than ALT, miR-122 or GLDH and has potential significant utility in the early identification of DILI in trials and clinical practice.
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Affiliation(s)
- Kathleen M Scullion
- Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Iain M MacIntyre
- Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Sian Sloan-Dennison
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, 99 George Street, Glasgow, G1 1RD, UK
| | - Benjamin Clark
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, 99 George Street, Glasgow, G1 1RD, UK
| | - Paul Fineran
- Centre for Inflammation Research, Translational Healthcare Technologies Group, Institute for Regeneration and Repair, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Joanne Mair
- Centre for Inflammation Research, Translational Healthcare Technologies Group, Institute for Regeneration and Repair, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - David Creasey
- Wasatch Photonics, 808 Aviation Parkway, Suite 1400, Morrisville, North Carolina, 27560, USA
| | - Cicely Rathmell
- Wasatch Photonics, 808 Aviation Parkway, Suite 1400, Morrisville, North Carolina, 27560, USA
| | - Karen Faulds
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, 99 George Street, Glasgow, G1 1RD, UK
| | - Duncan Graham
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, 99 George Street, Glasgow, G1 1RD, UK
| | - David J Webb
- Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - James W Dear
- Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Centre for Precision Cell Therapy for the Liver, Lothian Health Board, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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MacIntyre IM, Turtle EJ, Farrah TE, Graham C, Dear JW, Webb DJ. Regular Acetaminophen Use and Blood Pressure in People With Hypertension: The PATH-BP Trial. Circulation 2022; 145:416-423. [PMID: 35130054 PMCID: PMC7612370 DOI: 10.1161/circulationaha.121.056015] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acetaminophen is widely used as first-line therapy for chronic pain because of its perceived safety and the assumption that, unlike nonsteroidal anti-inflammatory drugs, it has little or no effect on blood pressure (BP). Although observational studies suggest that acetaminophen may increase BP, clinical trials are lacking. We, therefore, studied the effects of regular acetaminophen dosing on BP in individuals with hypertension. METHODS In this double-blind, placebo-controlled, crossover study, 110 individuals were randomized to receive 1 g acetaminophen 4× daily or matched placebo for 2 weeks followed by a 2-week washout period before crossing over to the alternate treatment. At the beginning and end of each treatment period, 24-hour ambulatory BPs were measured. The primary outcome was a comparison of the change in mean daytime systolic BP from baseline to end of treatment between the placebo and acetaminophen arms. RESULTS One-hundred three patients completed both arms of the study. Regular acetaminophen, compared with placebo, resulted in a significant increase in mean daytime systolic BP (132.8±10.5 to 136.5±10.1 mm Hg [acetaminophen] vs 133.9±10.3 to 132.5±9.9 mm Hg [placebo]; P<0.0001) with a placebo-corrected increase of 4.7 mm Hg (95% CI, 2.9-6.6) and mean daytime diastolic BP (81.2±8.0 to 82.1±7.8 mm Hg [acetaminophen] vs 81.7±7.9 to 80.9±7.8 mm Hg [placebo]; P=0.005) with a placebo-corrected increase of 1.6 mm Hg (95% CI, 0.5-2.7). Similar findings were seen for 24-hour ambulatory and clinic BPs. CONCLUSIONS Regular daily intake of 4 g acetaminophen increases systolic BP in individuals with hypertension by ≈5 mm Hg when compared with placebo; this increases cardiovascular risk and calls into question the safety of regular acetaminophen use in this situation. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01997112. URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2013-003204-40.
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Affiliation(s)
- Iain M MacIntyre
- Department of Renal Medicine, Royal Infirmary of Edinburgh, National Health Service Lothian, UK (I.M.M., T.E.F.)
| | - Emma J Turtle
- Department of Renal Medicine, Royal Infirmary of Edinburgh, National Health Service Lothian, UK (I.M.M., T.E.F.)
| | - Tariq E Farrah
- University/British Heart Foundation Center of Research Excellence, Center for Cardiovascular Science, Queen's Medical Research Institute (I.M.M., E.J.T., T.E.F., J.W.D., D.J.W.), University of Edinburgh, UK
| | - Catriona Graham
- Edinburgh Clinical Research Facility (C.G.), University of Edinburgh, UK
| | - James W Dear
- University/British Heart Foundation Center of Research Excellence, Center for Cardiovascular Science, Queen's Medical Research Institute (I.M.M., E.J.T., T.E.F., J.W.D., D.J.W.), University of Edinburgh, UK
| | - David J Webb
- University/British Heart Foundation Center of Research Excellence, Center for Cardiovascular Science, Queen's Medical Research Institute (I.M.M., E.J.T., T.E.F., J.W.D., D.J.W.), University of Edinburgh, UK
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Edwards NC, Price AM, Mehta S, Hiemstra TF, Kaur A, Greasley PJ, Webb DJ, Dhaun N, MacIntyre IM, Farrah T, Melville V, Herrey AS, Slinn G, Wale R, Ives N, Wheeler DC, Wilkinson I, Steeds RP, Ferro CJ, Townend JN. Effects of Spironolactone and Chlorthalidone on Cardiovascular Structure and Function in Chronic Kidney Disease: A Randomized, Open-Label Trial. Clin J Am Soc Nephrol 2021; 16:1491-1501. [PMID: 34462286 PMCID: PMC8499017 DOI: 10.2215/cjn.01930221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/08/2021] [Accepted: 08/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES In a randomized double-blind, placebo-controlled trial, treatment with spironolactone in early-stage CKD reduced left ventricular mass and arterial stiffness compared with placebo. It is not known if these effects were due to BP reduction or specific vascular and myocardial effects of spironolactone. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A prospective, randomized, open-label, blinded end point study conducted in four UK centers (Birmingham, Cambridge, Edinburgh, and London) comparing spironolactone 25 mg to chlorthalidone 25 mg once daily for 40 weeks in 154 participants with nondiabetic stage 2 and 3 CKD (eGFR 30-89 ml/min per 1.73 m2). The primary end point was change in left ventricular mass on cardiac magnetic resonance imaging. Participants were on treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and had controlled BP (target ≤130/80 mm Hg). RESULTS There was no significant difference in left ventricular mass regression; at week 40, the adjusted mean difference for spironolactone compared with chlorthalidone was -3.8 g (95% confidence interval, -8.1 to 0.5 g, P=0.08). Office and 24-hour ambulatory BPs fell in response to both drugs with no significant differences between treatment. Pulse wave velocity was not significantly different between groups; at week 40, the adjusted mean difference for spironolactone compared with chlorthalidone was 0.04 m/s (-0.4 m/s, 0.5 m/s, P=0.90). Hyperkalemia (defined ≥5.4 mEq/L) occurred more frequently with spironolactone (12 versus two participants, adjusted relative risk was 5.5, 95% confidence interval, 1.4 to 22.1, P=0.02), but there were no patients with severe hyperkalemia (defined ≥6.5 mEq/L). A decline in eGFR >30% occurred in eight participants treated with chlorthalidone compared with two participants with spironolactone (adjusted relative risk was 0.2, 95% confidence interval, 0.05 to 1.1, P=0.07). CONCLUSIONS Spironolactone was not superior to chlorthalidone in reducing left ventricular mass, BP, or arterial stiffness in nondiabetic CKD.
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Affiliation(s)
- Nicola C. Edwards
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Cardiology, Green Lane Cardiovascular Unit, Auckland, New Zealand
| | - Anna M. Price
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Samir Mehta
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Thomas F. Hiemstra
- Cambridge Clinical Trials Unit, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom,GlaxoSmithKline, England, United Kingdom
| | - Amreen Kaur
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Peter J. Greasley
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - David J. Webb
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom
| | - Neeraj Dhaun
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom,Department of Nephrology, National Health Services Lothian, Edinburgh, United Kingdom
| | - Iain M. MacIntyre
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom,Department of Nephrology, National Health Services Lothian, Edinburgh, United Kingdom
| | - Tariq Farrah
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom,Department of Nephrology, National Health Services Lothian, Edinburgh, United Kingdom
| | - Vanessa Melville
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom
| | - Anna S. Herrey
- UCL Institute of Cardiovascular Science and Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Gemma Slinn
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Rebekah Wale
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - David C. Wheeler
- Department of Renal Medicine, University College London, United Kingdom,George Institute for Global Health, Sydney, Australia
| | - Ian Wilkinson
- Cambridge Clinical Trials Unit, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom,GlaxoSmithKline, England, United Kingdom
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - Charles J. Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jonathan N. Townend
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom
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McCallum L, Brooksbank K, McConnachie A, Aman A, Lip S, Dawson J, MacIntyre IM, MacDonald TM, Webb DJ, Padmanabhan S. Rationale and Design of the Genotype-Blinded Trial of Torasemide for the Treatment of Hypertension (BHF UMOD). Am J Hypertens 2021; 34:92-99. [PMID: 33084880 PMCID: PMC7891239 DOI: 10.1093/ajh/hpaa166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Genome-wide association studies have identified single nucleotide polymorphisms (SNPs) near the uromodulin gene (UMOD) affecting uromodulin excretion and blood pressure (BP). Uromodulin is almost exclusively expressed in the thick ascending limb (TAL) of the loop of Henle and its effect on BP appears to be mediated via the TAL sodium transporter, NKCC2. Loop-diuretics block NKCC2 but are not commonly used in hypertension management. Volume overload is one of the primary drivers for uncontrolled hypertension, so targeting loop-diuretics to individuals who are more likely to respond to this drug class, using the UMOD genotype, could be an efficient precision medicine strategy. METHODS The BHF UMOD Trial is a genotype-blinded, multicenter trial comparing BP response to torasemide between individuals possessing the AA genotype of the SNP rs13333226 and those possessing the G allele. 240 participants (≥18 years) with uncontrolled BP, on ≥1 antihypertensive agent for ≥3 months, will receive treatment with Torasemide, 5 mg daily for 16 weeks. Uncontrolled BP is average home systolic BP (SBP) >135 mmHg and/or diastolic BP >85 mmHg. The primary outcome is the change in 24-hour ambulatory SBP area under the curve between baseline and end of treatment. Sample size was calculated to detect a 4 mmHg difference between groups at 90% power. Approval by West of Scotland Research Ethics Committee 5 (16/WS/0160). RESULTS The study should conclude August 2021. CONCLUSIONS If our hypothesis is confirmed, a genotype-based treatment strategy for loop diuretics would help reduce the burden of uncontrolled hypertension. CLINICAL TRIALS REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03354897.
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Affiliation(s)
- Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Katriona Brooksbank
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alisha Aman
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Stefanie Lip
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Iain M MacIntyre
- Clinical Pharmacology Unit and Research Centre, University of Edinburgh/BHF Centre of Research Excellence, Edinburgh, UK
| | - Thomas M MacDonald
- MEMO Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - David J Webb
- Clinical Pharmacology Unit and Research Centre, University of Edinburgh/BHF Centre of Research Excellence, Edinburgh, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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O'Sullivan ED, MacIntyre IM. Individual patient risk assessment and cost-benefit analysis of patiromer in AMBER. Lancet 2020; 396:311. [PMID: 32738951 DOI: 10.1016/s0140-6736(20)30545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Eoin D O'Sullivan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
| | - Iain M MacIntyre
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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Hunter RW, Moorhouse R, Farrah TE, MacIntyre IM, Asai T, Gallacher PJ, Kerr D, Melville V, Czopek A, Morrison EE, Ivy JR, Dear JW, Bailey MA, Goddard J, Webb DJ, Dhaun N. First-in-Man Demonstration of Direct Endothelin-Mediated Natriuresis and Diuresis. Hypertension 2017; 70:192-200. [PMID: 28507171 PMCID: PMC5739104 DOI: 10.1161/hypertensionaha.116.08832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/30/2016] [Revised: 12/19/2016] [Accepted: 04/19/2017] [Indexed: 01/23/2023]
Abstract
Endothelin (ET) receptor antagonists are potentially novel therapeutic agents in chronic kidney disease and resistant hypertension, but their use is complicated by sodium and water retention. In animal studies, this side effect arises from ETB receptor blockade in the renal tubule. Previous attempts to determine whether this mechanism operates in humans have been confounded by the hemodynamic consequences of ET receptor stimulation/blockade. We aimed to determine the effects of ET signaling on salt transport in the human nephron by administering subpressor doses of the ET-1 precursor, big ET-1. We conducted a 2-phase randomized, double-blind, placebo-controlled crossover study in 10 healthy volunteers. After sodium restriction, subjects received either intravenous placebo or big ET-1, in escalating dose (≤300 pmol/min). This increased plasma concentration and urinary excretion of ET-1. Big ET-1 reduced heart rate (≈8 beats/min) but did not otherwise affect systemic hemodynamics or glomerular filtration rate. Big ET-1 increased the fractional excretion of sodium (from 0.5 to 1.0%). It also increased free water clearance and tended to increase the abundance of the sodium-potassium-chloride cotransporter (NKCC2) in urinary extracellular vesicles. Our protocol induced modest increases in circulating and urinary ET-1. Sodium and water excretion increased in the absence of significant hemodynamic perturbation, supporting a direct action of ET-1 on the renal tubule. Our data also suggest that sodium reabsorption is stimulated by ET-1 in the thick ascending limb and suppressed in the distal renal tubule. Fluid retention associated with ET receptor antagonist therapy may be circumvented by coprescribing potassium-sparing diuretics.
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Affiliation(s)
- Robert W Hunter
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Rebecca Moorhouse
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Tariq E Farrah
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Iain M MacIntyre
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Takae Asai
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Peter J Gallacher
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Debbie Kerr
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Vanessa Melville
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Alicja Czopek
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Emma E Morrison
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Jess R Ivy
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - James W Dear
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Matthew A Bailey
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Jane Goddard
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - David J Webb
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Neeraj Dhaun
- From the British Heart Foundation Centre of Research Excellence and The Queen's Medical Research Institute, University of Edinburgh, United Kingdom.
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7
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Balmforth C, van Bragt JJ, Ruijs T, Cameron JR, Kimmitt R, Moorhouse R, Czopek A, Hu MK, Gallacher PJ, Dear JW, Borooah S, MacIntyre IM, Pearson TM, Willox L, Talwar D, Tafflet M, Roubeix C, Sennlaub F, Chandran S, Dhillon B, Webb DJ, Dhaun N. Chorioretinal thinning in chronic kidney disease links to inflammation and endothelial dysfunction. JCI Insight 2016; 1:e89173. [PMID: 27942587 PMCID: PMC5135281 DOI: 10.1172/jci.insight.89173] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND. Chronic kidney disease (CKD) is strongly associated with cardiovascular disease and there is an established association between vasculopathy affecting the kidney and eye. Optical coherence tomography (OCT) is a novel, rapid method for high-definition imaging of the retina and choroid. Its use in patients at high cardiovascular disease risk remains unexplored. METHODS. We used the new SPECTRALIS OCT machine to examine retinal and retinal nerve fiber layer (RNFL) thickness, macular volume, and choroidal thickness in a prospective cross-sectional study in 150 subjects: 50 patients with hypertension (defined as a documented clinic BP greater than or equal to 140/90 mmHg (prior to starting any treatment) with no underlying cause identified); 50 with CKD (estimated glomerular filtration rate (eGFR) 8–125 ml/min/1.73 m2); and 50 matched healthy controls. We excluded those with diabetes. The same, masked ophthalmologist carried out each study. Plasma IL-6, TNF-α , asymmetric dimethylarginine (ADMA), and endothelin-1 (ET-1), as measures of inflammation and endothelial function, were also assessed. RESULTS. Retinal thickness, macular volume, and choroidal thickness were all reduced in CKD compared with hypertensive and healthy subjects (for retinal thickness and macular volume P < 0.0001 for CKD vs. healthy and for CKD vs. hypertensive subjects; for choroidal thickness P < 0.001 for CKD vs. healthy and for CKD vs. hypertensive subjects). RNFL thickness did not differ between groups. Interestingly, a thinner choroid was associated with a lower eGFR (r = 0.35, P <0.0001) and, in CKD, with proteinuria (r = –0.58, P < 0.001) as well as increased circulating C-reactive protein (r = –0.57, P = 0.0002), IL-6 (r = –0.40, P < 0.01), ADMA (r = –0.37, P = 0.02), and ET-1 (r = –0.44, P < 0.01). Finally, choroidal thinning was associated with renal histological inflammation and arterial stiffness. In a model of hypertension, choroidal thinning was seen only in the presence of renal injury. CONCLUSIONS. Chorioretinal thinning in CKD is associated with lower eGFR and greater proteinuria, but not BP. Larger studies, in more targeted groups of patients, are now needed to clarify whether these eye changes reflect the natural history of CKD. Similarly, the associations with arterial stiffness, inflammation, and endothelial dysfunction warrant further examination. TRIAL REGISTRATION. Registration number at www.clinicalTrials.gov: NCT02132741. SOURCE OF FUNDING. TR was supported by a bursary from the Erasmus Medical Centre, Rotterdam. JJMHvB was supported by a bursary from the Utrecht University. JRC is supported by a Rowling Scholarship. SB was supported by a Wellcome Trust funded clinical research fellowship from the Scottish Translational Medicine and Therapeutics Initiative, and by a Rowling Scholarship, at the time of this work. ND is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/13/30/29994). Chorioretinal thinning relates to the degree of inflammation and kidney injury in patients with kidney disease.
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Affiliation(s)
- Craig Balmforth
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Job Jmh van Bragt
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Titia Ruijs
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - James R Cameron
- Anne Rowling Regenerative Neurology Clinic, Centre for Clinical Brain Sciences, University of Edinburgh
| | - Robert Kimmitt
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Rebecca Moorhouse
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Alicja Czopek
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - May Khei Hu
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Peter J Gallacher
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - James W Dear
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Shyamanga Borooah
- Anne Rowling Regenerative Neurology Clinic, Centre for Clinical Brain Sciences, University of Edinburgh.,Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - Iain M MacIntyre
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Tom Mc Pearson
- Anne Rowling Regenerative Neurology Clinic, Centre for Clinical Brain Sciences, University of Edinburgh
| | - Laura Willox
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Infirmary of Glasgow, United Kingdom
| | - Dinesh Talwar
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Infirmary of Glasgow, United Kingdom
| | - Muriel Tafflet
- INSERM Unit 970, Paris Cardiovascular Research Center - PARCC and Descartes University, Paris, France
| | - Christophe Roubeix
- Institut National de la Santé et de la Recherche Médicale, Institut de la Vision, Paris, France
| | - Florian Sennlaub
- Institut National de la Santé et de la Recherche Médicale, Institut de la Vision, Paris, France
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, Centre for Clinical Brain Sciences, University of Edinburgh
| | - Baljean Dhillon
- Anne Rowling Regenerative Neurology Clinic, Centre for Clinical Brain Sciences, University of Edinburgh.,Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - David J Webb
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
| | - Neeraj Dhaun
- BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh
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Abstract
The incidence and prevalence of chronic kidney disease (CKD) is increasing. Despite current therapies, many patients with CKD have suboptimal blood pressure, ongoing proteinuria, and develop progressive renal dysfunction. Further therapeutic options therefore are required. Over the past 20 years the endothelin (ET) system has become a prime target. Experimental models have shown that ET-1, acting primarily via the endothelin-A receptor, plays an important role in the development of proteinuria, glomerular injury, fibrosis, and inflammation. Subsequent animal and early clinical studies using ET-receptor antagonists have suggested that theses therapies may slow renal disease progression primarily through blood pressure and proteinuria reduction. This review examines the current literature regarding the ET system in nondiabetic CKD.
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Affiliation(s)
- Geoff J Culshaw
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK.
| | - Iain M MacIntyre
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK
| | - Neeraj Dhaun
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK
| | - David J Webb
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK
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9
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Dhaun N, Yuzugulen J, Kimmitt RA, Wood EG, Chariyavilaskul P, MacIntyre IM, Goddard J, Webb DJ, Corder R. Plasma pro-endothelin-1 peptide concentrations rise in chronic kidney disease and following selective endothelin A receptor antagonism. J Am Heart Assoc 2015; 4:e001624. [PMID: 25801761 PMCID: PMC4392442 DOI: 10.1161/jaha.114.001624] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Endothelin 1 (ET‐1) contributes to chronic kidney disease (CKD) development and progression, and endothelin receptor antagonists are being investigated as a novel therapy for CKD. The proET‐1 peptides, endothelin‐like domain peptide (ELDP) and C‐terminal pro‐ET‐1 (CT‐proET‐1), are both potential biomarkers of CKD and response to therapy with endothelin antagonists. Methods and Results We assessed plasma and urine ELDP and plasma CT‐proET‐1 in CKD patients with minimal comorbidity. Next, in a randomized double‐blind crossover study of 27 subjects with proteinuric CKD, we examined the effects of 6 weeks of treatment with placebo, sitaxentan (endothelin A antagonist), and nifedipine on these peptides alongside the primary end points of proteinuria, blood pressure, and arterial stiffness. Plasma ELDP and CT‐proET‐1 increased with CKD stage (both P<0.0001), correlating inversely with estimated glomerular filtration rate (both P<0.0001). Following intervention, placebo and nifedipine did not affect plasma and urine ELDP or plasma CT‐proET‐1. Sitaxentan increased both plasma ELDP and CT‐proET‐1 (baseline versus week 6±SEM: ELDP, 11.8±0.5 versus 13.4±0.6 fmol/mL; CT‐proET‐1, 20.5±1.2 versus 23.3±1.5 fmol/mL; both P<0.0001). Plasma ET‐1 was unaffected by any treatment. Following sitaxentan, plasma ELDP and CT‐proET‐1 correlated negatively with 24‐hour urinary sodium excretion. Conclusions ELDP and CT‐proET‐1 increase in CKD and thus are potentially useful biomarkers of renal injury. Increases in response to endothelin A antagonism may reflect EDN1 upregulation, which may partly explain fluid retention with these agents. Clinical Trial Registration URL: www.clinicalTrials.gov Unique identifier: NCT00810732
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Affiliation(s)
- Neeraj Dhaun
- BHF Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK (N.D., R.A.K., P.C., I.M.M.I., D.J.W.) Department of Renal Medicine, Royal Infirmary of Edinburgh, UK (N.D., J.G.)
| | - Jale Yuzugulen
- William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, UK (J.Y., E.G.W., R.C.)
| | - Robert A Kimmitt
- BHF Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK (N.D., R.A.K., P.C., I.M.M.I., D.J.W.)
| | - Elizabeth G Wood
- William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, UK (J.Y., E.G.W., R.C.)
| | - Pajaree Chariyavilaskul
- BHF Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK (N.D., R.A.K., P.C., I.M.M.I., D.J.W.)
| | - Iain M MacIntyre
- BHF Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK (N.D., R.A.K., P.C., I.M.M.I., D.J.W.)
| | - Jane Goddard
- Department of Renal Medicine, Royal Infirmary of Edinburgh, UK (N.D., J.G.)
| | - David J Webb
- BHF Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK (N.D., R.A.K., P.C., I.M.M.I., D.J.W.)
| | - Roger Corder
- William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, UK (J.Y., E.G.W., R.C.)
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Dhaun N, Moorhouse R, MacIntyre IM, Melville V, Oosthuyzen W, Kimmitt RA, Brown KE, Kennedy ED, Goddard J, Webb DJ. Diurnal variation in blood pressure and arterial stiffness in chronic kidney disease: the role of endothelin-1. Hypertension 2014; 64:296-304. [PMID: 24890823 DOI: 10.1161/hypertensionaha.114.03533] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Hypertension and arterial stiffness are important independent cardiovascular risk factors in chronic kidney disease (CKD) to which endothelin-1 (ET-1) contributes. Loss of nocturnal blood pressure (BP) dipping is associated with CKD progression, but there are no data on 24-hour arterial stiffness variation. We examined the 24-hour variation of BP, arterial stiffness, and the ET system in healthy volunteers and patients with CKD and the effects on these of ET receptor type A receptor antagonism (sitaxentan). There were nocturnal dips in systolic BP and diastolic BP and pulse wave velocity, our measure of arterial stiffness, in 15 controls (systolic BP, −3.2±4.8%, P<0.05; diastolic BP, −6.4±6.2%, P=0.001; pulse wave velocity, −5.8±5.2%, P<0.01) but not in 15 patients with CKD. In CKD, plasma ET-1 increased by 1.2±1.4 pg/mL from midday to midnight compared with healthy volunteers (P<0.05). Urinary ET-1 did not change. In a randomized, double-blind, 3-way crossover study in 27 patients with CKD, 6-week treatment with placebo and nifedipine did not affect nocturnal dips in systolic BP or diastolic BP between baseline and week 6, whereas dipping was increased after 6-week sitaxentan treatment (baseline versus week 6, systolic BP: −7.0±6.2 versus −11.0±7.8 mm Hg, P<0.05; diastolic BP: −6.0±3.6 versus −8.3±5.1 mm Hg, P<0.05). There was no nocturnal dip in pulse pressure at baseline in the 3 phases of the study, whereas sitaxentan was linked to the development of a nocturnal dip in pulse pressure. In CKD, activation of the ET system seems to contribute not only to raised BP but also the loss of BP dipping. The clinical significance of these findings should be explored in future clinical trials.
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Phillips LA, MacIntyre IM, Webb DJ. Development of an in vivo protocol for investigating natriuretic mechanisms in response to acute sodium loading in humans. BMC Proc 2012. [PMCID: PMC3426093 DOI: 10.1186/1753-6561-6-s4-o45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Dhaun N, MacIntyre IM, Kerr D, Melville V, Johnston NR, Haughie S, Goddard J, Webb DJ. Selective Endothelin-A Receptor Antagonism Reduces Proteinuria, Blood Pressure, and Arterial Stiffness in Chronic Proteinuric Kidney Disease. Hypertension 2011; 57:772-9. [DOI: 10.1161/hypertensionaha.110.167486] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [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
Proteinuria is associated with adverse cardiovascular and renal outcomes that are not prevented by current treatments. Endothelin 1 promotes the development and progression of chronic kidney disease and associated cardiovascular disease. We, therefore, studied the effects of selective endothelin-A receptor antagonism in proteinuric chronic kidney disease patients, assessing proteinuria, blood pressure (BP), and arterial stiffness, key independent, surrogate markers of chronic kidney disease progression and cardiovascular disease risk. In a randomized, double-blind, 3-way crossover study, 27 subjects on recommended renoprotective treatment received 6 weeks of placebo, 100 mg once daily of sitaxsentan, and 30 mg once daily of nifedipine long acting. Twenty-four–hour proteinuria, protein:creatinine ratio, 24-hour ambulatory BP, and pulse wave velocity (as a measure of arterial stiffness) were measured at baseline and week 6 of each treatment. In 13 subjects, renal blood flow and glomerular filtration rate were assessed at baseline and week 6 of each period. Compared with placebo, sitaxsentan reduced 24-hour proteinuria (−0.56±0.20 g/d;
P
=0.0069), protein:creatinine ratio (−38±15 mg/mmol;
P
=0.0102), BP (−3.4±1.2 mm Hg;
P
=0.0069), and pulse wave velocity (−0.64±0.24 m/s;
P
=0.0052). Nifedipine matched the BP and pulse wave velocity reductions seen with sitaxsentan but did not reduce proteinuria. Sitaxsentan alone reduced both glomerular filtration rate and filtration fraction. It caused no clinically significant adverse effects. Endothelin-A receptor antagonism may provide additional cardiovascular and renal protection by reducing proteinuria, BP, and arterial stiffness in optimally treated chronic kidney disease subjects. The antiproteinuric effects of sitaxsentan likely relate to changes in BP and renal hemodynamics.
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Affiliation(s)
- Neeraj Dhaun
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - Iain M. MacIntyre
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - Debbie Kerr
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - Vanessa Melville
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - Neil R. Johnston
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - Scott Haughie
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - Jane Goddard
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
| | - David J. Webb
- From the Clinical Pharmacology Unit (N.D., I.M.M., D.K., V.M., N.R.J., D.J.W.) British Heart Foundation (BHF) Centre of Research Excellence (CoRE), University of Edinburgh, the Queen's Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Pfizer Ltd (S.H.), Sandwich, Kent, United Kingdom
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MacIntyre IM, Dhaun N, Lilitkarntakul P, Melville V, Goddard J, Webb DJ. Greater Functional ET
B
Receptor Antagonism With Bosentan Than Sitaxsentan in Healthy Men. Hypertension 2010; 55:1406-11. [DOI: 10.1161/hypertensionaha.109.148569] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Iain M. MacIntyre
- From the Clinical Pharmacology Unit (I.M.M., N.D., P.L., V.M., D.J.W.), Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Neeraj Dhaun
- From the Clinical Pharmacology Unit (I.M.M., N.D., P.L., V.M., D.J.W.), Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Pajaree Lilitkarntakul
- From the Clinical Pharmacology Unit (I.M.M., N.D., P.L., V.M., D.J.W.), Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Vanessa Melville
- From the Clinical Pharmacology Unit (I.M.M., N.D., P.L., V.M., D.J.W.), Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jane Goddard
- From the Clinical Pharmacology Unit (I.M.M., N.D., P.L., V.M., D.J.W.), Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David J. Webb
- From the Clinical Pharmacology Unit (I.M.M., N.D., P.L., V.M., D.J.W.), Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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14
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Dhaun N, MacIntyre IM, Bellamy CO, Kluth DC. Endothelin Receptor Antagonism and Renin Inhibition as Treatment Options for Scleroderma Kidney. Am J Kidney Dis 2009; 54:726-31. [DOI: 10.1053/j.ajkd.2009.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 02/13/2009] [Indexed: 11/11/2022]
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Abstract
BACKGROUND The use of mesh for groin hernia repair has dramatically changed the way this common operation is performed. The aim of this study was to survey the methods of groin hernia repair in Scotland and to assess patient satisfaction with the operation. METHODS Between 1 April 1998 and 31 March 1999 all patients who underwent groin hernia repair in the National Health Service in Scotland were identified. As well as looking at the type of hernia repair performed and postoperative morbidity, patients were sent a Short Form-36 about 3 months after the operation to assess satisfaction and return to normal activity. RESULTS Information was obtained on 5506 (97 per cent) of patients who underwent groin hernia repair during the study period. Eighty-five per cent of patients had an open mesh repair and 4 per cent had a laparoscopic repair. Most operations (85 per cent) were performed using general anaesthesia on an inpatient basis (78 per cent), and 8 per cent were for repair of a recurrent hernia. Potentially serious intraoperative complications were rare (seven patients), although they were significantly (P < 0. 001) more likely to be associated with a laparoscopic approach or repair of a femoral hernia: relative risk compared with open inguinal hernia repair 33 (95 per cent confidence interval (c.i.) 6-197) and 22 (95 per cent c.i. 3-152) respectively. Wound complications were common and 10 per cent of patients required a district nurse to attend the wound. Patients expressed a high degree of satisfaction; 94 per cent would recommend the same operation to someone else if required. CONCLUSION An open mesh repair using general anaesthesia has become the repair of choice for a groin hernia in Scotland. Despite a high incidence of wound complications, patients are satisfied with this operation.
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Affiliation(s)
- A Hair
- University Department of Surgery, Western Infirmary, Glasgow, Western General Hospital, Edinburgh and Health Economics Unit, Greater Glasgow Health Board, Glasgow, UK
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16
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Kumar S, Nixon SJ, MacIntyre IM. Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit's experience. J R Coll Surg Edinb 1999; 44:301-2. [PMID: 10550952] [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: 02/14/2023]
Abstract
Surgical treatment of recurrent inguinal hernia is controversial. This is a prospective study of 50 patients who had laparoscopic total extraperitoneal repair (n = 25) or Lichtenstein repair (n = 25) for recurrent inguinal hernia. The two groups of patients were comparable in age, sex and type of hernia. Post-operatively, a seroma or a wound haematoma developed in 12 patients after Lichtenstein repair and in 4 patients after laparoscopic repair (p < 0.05). On average, analgesia was taken for 6.4 days after Lichtenstein repair compared with 3.4 days after laparoscopic repair (p < 0.05). In our unit, laparoscopic repair was associated with fewer complications and a significantly shorter duration of post-operative analgesia than Lichtenstein repair for recurrent inguinal hernia.
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Affiliation(s)
- S Kumar
- Department of General Surgery, Western General Hospital NHS Trust, Edinburgh, U.K
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Abstract
Adenocarcinoma of the stomach distal to the cardia remains one of the most common cancers in the world. The interest in the aetiology of this disease has been rekindled because of recent epidemiological and molecular studies linking this cancer to H. pylori and certain dietary factors. The authors provide an updated review of the aetiology of gastric cancer. This review seeks to summarize the disease, to propose pathways of carcinogenesis and to suggest ways in which the "traditional" risk factors may be interpreted on the basis of evolving knowledge.
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Affiliation(s)
- A K Kubba
- Department of Surgery, The Western General Hospital, Edinburgh, UK
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18
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Abstract
We report two cases of gastric carcinoma where repeated, multiple conventional endoscopic biopsies were falsely negative. Endoscopic mucosal resection gave a positive diagnosis in both these patients. New equipment for aspiration mucosectomy makes the technique easier to perform, and a larger, deeper biopsy is obtained.
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Affiliation(s)
- S Ghosh
- Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland
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19
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Abstract
The extent to which the different resections relieve the symptoms of gastric cancer is poorly defined. The symptoms of 57 consecutive patients undergoing standard resection of gastric adenocarcinoma by oesophagogastrectomy (n = 19), total gastrectomy [16] or partial gastrectomy [22] were studied prospectively. Common symptoms were relieved in 80% of cases and this was independent of tumour stage. Symptoms were significantly more frequent after total gastrectomy than after partial gastrectomy or oesophagogastrectomy, the difference being attributable principally to the development of new symptoms after total gastrectomy. While abdominal pain, nausea and vomiting were largely relieved by resection, dyspepsia or dysphagia worsened in 31% of patients following surgery, especially total gastrectomy (P < 0.05). Resection relieves the symptoms of gastric cancer adequately but outcome is influenced by operation type. As total gastrectomy gives a poorer symptomatic outcome, it should be avoided when the performance of an alternative procedure does not compromise established principles of resection.
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Affiliation(s)
- I D Anderson
- Department of Surgery, Western General Hospital, Edinburgh, UK
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20
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Wyatt JP, Varma JS, MacIntyre IM. Prolonged dysphagia after highly selective vagotomy. J R Coll Surg Edinb 1993; 38:43-4. [PMID: 8437153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- J P Wyatt
- Department of Surgery, Western General Hospital, Edinburgh, UK
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21
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Varma JS, Wyatt JP, MacIntyre IM. Gastric volvulus caused by giant ovarian cyst. J R Coll Surg Edinb 1992; 37:194. [PMID: 1404048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- J S Varma
- Department of Surgery, Western General Hospital, Edinburgh, UK
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22
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23
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24
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MacIntyre IM. Open-access endoscopy for general practitioners. Practitioner 1988; 232:348-51. [PMID: 3217343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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25
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Robbs JV, MacIntyre IM. The efficiency of intraperitoneal drains--an experimental study. S AFR J SURG 1979; 17:191-7. [PMID: 551545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
A patient who developed hiccups after laparotomy was treated with numerous drugs with limited success. A left phrenic nerve crush was eventually successful. A review of published work showed that the drugs most likely to succeed were chlorpromazine and metoclopramide, and that phrenic nerve injection and crush should be considered if these failed.
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27
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28
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MacIntyre IM, Strange DM, Beavis JP. L-dopa and general anaesthesia. Anaesthesia 1971; 26:370-2. [PMID: 5090234 DOI: 10.1111/j.1365-2044.1971.tb04801.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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