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François B, Lambden S, Fivez T, Gibot S, Derive M, Grouin JM, Salcedo-Magguilli M, Lemarié J, De Schryver N, Jalkanen V, Hicheur T, Garaud JJ, Cuvier V, Ferrer R, Bestle M, Pettilä V, Mira JP, Bouisse C, Mercier E, Vermassen J, Huberlant V, Vinatier I, Anguel N, Levy M, Laterre PF. Prospective evaluation of the efficacy, safety, and optimal biomarker enrichment strategy for nangibotide, a TREM-1 inhibitor, in patients with septic shock (ASTONISH): a double-blind, randomised, controlled, phase 2b trial. Lancet Respir Med 2023; 11:894-904. [PMID: 37269870 DOI: 10.1016/s2213-2600(23)00158-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Activation of the triggering receptor expressed on myeloid cells-1 (TREM-1) pathway is associated with septic shock outcomes. Data suggest that modulation of this pathway in patients with activated TREM-1 might improve survival. Soluble TREM-1 (sTREM-1), a potential mechanism-based biomarker, might facilitate enrichment of patient selection in clinical trials of nangibotide, a TREM-1 modulator. In this phase 2b trial, we aimed to confirm the hypothesis that TREM1 inhibition might improve outcomes in patients with septic shock. METHODS This double-blind, randomised, placebo-controlled, phase 2b trial assessed the efficacy and safety of two different doses of nangibotide compared with placebo, and aimed to identify the optimum treatment population, in patients across 42 hospitals with medical, surgical, or mixed intensive care units (ICUs) in seven countries. Non-COVID-19 patients (18-85 years) meeting the standard definition of septic shock, with documented or suspected infection (lung, abdominal, or urinary [in patients ≥65 years]), were eligible within 24 h of vasopressor initiation for the treatment of septic shock. Patients were randomly assigned in a 1:1:1 ratio to intravenous nangibotide 0·3 mg/kg per h (low-dose group), nangibotide 1·0 mg/kg per h (high-dose group), or matched placebo, using a computer-generated block randomisation scheme (block size 3). Patients and investigators were masked to treatment allocation. Patients were grouped according to sTREM-1 concentrations at baseline (established from sepsis observational studies and from phase 2a change to data) into high sTREM-1 (≥ 400 pg/mL). The primary outcome was the mean difference in total Sequential Organ Failure Assessment (SOFA) score from baseline to day 5 in the low-dose and high-dose groups compared with placebo, measured in the predefined high sTREM-1 (≥ 400 pg/mL) population and in the overall modified intention-to-treat population. Secondary endpoints included all-cause 28-day mortality, safety, pharmacokinetics, and evaluation of the relationship between TREM-1 activation and treatment response. This study is registered with EudraCT, 2018-004827-36, and Clinicaltrials.gov, NCT04055909. FINDINGS Between Nov 14, 2019, and April 11, 2022, of 402 patients screened, 355 were included in the main analysis (116 in the placebo group, 118 in the low-dose group, and 121 in the high-dose group). In the preliminary high sTREM-1 population (total 253 [71%] of 355; placebo 75 [65%] of 116; low-dose 90 [76%] of 118; high-dose 88 [73%] of 121), the mean difference in SOFA score from baseline to day 5 was 0·21 (95% CI -1·45 to 1·87, p=0·80) in the low-dose group and 1·39 (-0·28 to 3·06, p=0·104) in the high-dose group versus placebo. In the overall population, the difference in SOFA score from baseline to day 5 between the placebo group and low-dose group was 0·20 (-1·09 to 1·50; p=0·76),and between the placebo group and the high-dose group was 1·06 (-0·23 to 2·35, p=0·108). In the predefined high sTREM-1 cutoff population, 23 (31%) patients in the placebo group, 35 (39%) in the low-dose group, and 25 (28%) in the high-dose group had died by day 28. In the overall population, 29 (25%) patients in the placebo, 38 (32%) in the low-dose, and 30 (25%) in the high-dose group had died by day 28. The number of treatment-emergent adverse events (111 [96%] patients in the placebo group, 113 [96%] in the low-dose group, and 115 [95%] in the high-dose group) and serious treatment-emergent adverse events (28 [24%], 26 [22%], and 31 [26%]) was similar between all three groups. High-dose nangibotide led to a clinically relevant improvement in SOFA score (of two points or more) from baseline to day 5 over placebo in those with higher cutoff concentrations (≥532 pg/mL) of sTREM-1 at baseline. Low dose nangibotide displayed a similar pattern with lower magnitude of effect across all cutoff values. INTERPRETATION This trial did not achieve the primary outcome of improvement in SOFA score at the predefined sTREM-1 value. Future studies are needed to confirm the benefit of nangibotide at higher concentrations of TREM-1 activation. FUNDING Inotrem.
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Affiliation(s)
- Bruno François
- Medical-Surgical ICU Department and Inserm CIC1435 & UMR1092, CRICS-TRIGGERSEP Network, CHU Limoges, Limoges, France.
| | - Simon Lambden
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK; Inotrem, Paris, France
| | - Tom Fivez
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sebastien Gibot
- Intensive Care Unit, Centre Hospitalier Regional Universitaire, Nancy, France
| | | | - Jean-Marie Grouin
- Statistics Department, Université de Rouen, Mont Saint-Aignan, France
| | | | | | | | - Ville Jalkanen
- Tampere University Hospital, Intensive Care Unit, Tampere, Finland
| | | | | | | | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, SODIR Research Group, Vall d'Hebron Institut de Recerca, Spain; Paseig de la Vall d'Hebron, Barcelona, Spain
| | - Morten Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Denmark; Department of Clinical Medicine, University of Copenhagen, Hilleroed, Denmark
| | - Ville Pettilä
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jean-Paul Mira
- Groupe Hospitalier Cochin St Vincent de Paul La Roche Guyon, Paris, France
| | - Camille Bouisse
- Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | | | | | | | - Isabelle Vinatier
- Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | | | - Mitchell Levy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
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Lambden S, Kelly P, Ahmetaj-Shala B, Wang Z, Lee B, Nandi M, Torondel B, Delahaye M, Dowsett L, Piper S, Tomlinson J, Caplin B, Colman L, Boruc O, Slaviero A, Zhao L, Oliver E, Khadayate S, Singer M, Arrigoni F, Leiper J. Dimethylarginine dimethylaminohydrolase 2 regulates nitric oxide synthesis and hemodynamics and determines outcome in polymicrobial sepsis. Arterioscler Thromb Vasc Biol 2015; 35:1382-92. [PMID: 25857313 DOI: 10.1161/atvbaha.115.305278] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 08/18/2014] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Nitric oxide is a key to numerous physiological and pathophysiological processes. Nitric oxide production is regulated endogenously by 2 methylarginines, asymmetric dimethylarginine (ADMA) and monomethyl-L-arginine. The enzyme that specifically metabolizes asymmetric dimethylarginine and monomethyl-L-arginine is dimethylarginine dimethylaminohydrolase (DDAH). The first isoform dimethylarginine dimethylaminohydrolase 1 has previously been shown to be an important regulator of methylarginines in both health and disease. This study explores for the first time the role of endogenous dimethylarginine dimethylaminohydrolase 2 in regulating cardiovascular physiology and also determines the functional impact of dimethylarginine dimethylaminohydrolase 2 deletion on outcome and immune function in sepsis. APPROACH AND RESULTS Mice, globally deficient in Ddah2, were compared with their wild-type littermates to determine the physiological role of Ddah2 using in vivo and ex vivo assessments of vascular function. We show that global knockout of Ddah2 results in elevated blood pressure during periods of activity (mean [SEM], 118.5 [1.3] versus 112.7 [1.1] mm Hg; P=0.025) and changes in vascular responsiveness mediated by changes in methylarginine concentration, mean myocardial tissue asymmetric dimethylarginine (SEM) was 0.89 (0.06) versus 0.67 (0.05) μmol/L (P=0.02) and systemic nitric oxide concentrations. In a model of severe polymicrobial sepsis, Ddah2 knockout affects outcome (120-hour survival was 12% in Ddah2 knockouts versus 53% in wild-type animals; P<0.001). Monocyte-specific deletion of Ddah2 results in a similar pattern of increased severity to that seen in globally deficient animals. CONCLUSIONS Ddah2 has a regulatory role both in normal physiology and in determining outcome of severe polymicrobial sepsis. Elucidation of this role identifies a mechanism for the observed relationship between Ddah2 polymorphisms, cardiovascular disease, and outcome in sepsis.
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Affiliation(s)
- Simon Lambden
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Peter Kelly
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Blerina Ahmetaj-Shala
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Zhen Wang
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Benjamin Lee
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Manasi Nandi
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Belen Torondel
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Matthew Delahaye
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Laura Dowsett
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Sophie Piper
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - James Tomlinson
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Ben Caplin
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Lucy Colman
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Olga Boruc
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Anna Slaviero
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Lan Zhao
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Eduardo Oliver
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Sanjay Khadayate
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Mervyn Singer
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Francesca Arrigoni
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - James Leiper
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.).
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