1
|
Hesketh LM, Wilder CDE, Ranadive NN, Lytra G, Qazimi P, Munro JS, Ahdi N, Curtis MJ. Characterisation of mexiletine's translational therapeutic index for suppression of ischaemia-induced ventricular fibrillation in the rat isolated heart. Sci Rep 2020; 10:8397. [PMID: 32439959 PMCID: PMC7242333 DOI: 10.1038/s41598-020-65190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/24/2020] [Indexed: 11/09/2022] Open
Abstract
The 'translational therapeutic index' (TTI) is a drug's ratio of nonclinical threshold dose (or concentration) for significant benefit versus threshold for adversity. In early nonclinical research, discovery and safety studies are normally undertaken separately. Our aim was to evaluate a novel integrated approach for generating a TTI for drugs intended for prevention of ischaemia-induced ventricular fibrillation (VF). We templated the current best available class 1b antiarrhythmic, mexiletine, using the rat Langendorff preparation. Mexiletine's beneficial effects on the incidence of VF caused by 120 min regional ischaemia were contrasted with its concurrent adverse effects (on several variables) in the same hearts, to generate a TTI. Mexiletine 0.1 and 0.5 µM had no adverse effects, but did not reduce VF incidence. Mexiletine 1 µM reduced VF incidence to 0% but had adverse effects on atrioventricular conduction and ventricular repolarization. Separate studies undertaken using an intraventricular balloon revealed no detrimental effects of mexiletine (1 and 5 µM) on mechanical function, or any benefit against reperfusion-related dysfunction. Mexiletine's TTI was found to be less than two, which accords with its clinical therapeutic index. Although non-cardiac adversity, identifiable from additional in vivo studies, may reduce the TTI further, it cannot increase it. Our experimental approach represents a useful early-stage integrated risk/benefit method that, when TTI is found to be low, would eliminate unsuitable class 1b drugs prior to next stage in vivo work, with mexiletine's TTI defining the gold standard that would need to be bettered.
Collapse
Affiliation(s)
- Louise M Hesketh
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Catherine D E Wilder
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Niraja N Ranadive
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Georgia Lytra
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Patrisia Qazimi
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Jade S Munro
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Nakita Ahdi
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Michael J Curtis
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
| |
Collapse
|
4
|
Koini EN, Papazafiri P, Vassilopoulos A, Koufaki M, Horváth Z, Koncz I, Virág L, Papp GJ, Varró A, Calogeropoulou T. 5,7,8-Trimethyl-benzopyran and 5,7,8-Trimethyl-1,4-benzoxazine Aminoamide Derivatives as Novel Antiarrhythmics against Ischemia−Reperfusion Injury. J Med Chem 2009; 52:2328-40. [DOI: 10.1021/jm801228h] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eftychia N. Koini
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Panagiota Papazafiri
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Athanasios Vassilopoulos
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Maria Koufaki
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Zoltán Horváth
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - István Koncz
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - László Virág
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Gy J. Papp
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Andràs Varró
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| | - Theodora Calogeropoulou
- Institute of Organic and Pharmaceutical Chemistry, National Hellenic Research Foundation, 48 Vas. Constantinou Avenue, 116 35 Athens, Greece, Department of Animal and Human Physiology, School of Biology, University of Athens, Panepistimiopolis, 15784 Athens, Greece, Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged Dom ter 12 H-6720, Hungary, Research Unit for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged Hungary
| |
Collapse
|
9
|
Baczkó I, El-Reyani NE, Farkas A, Virág L, Iost N, Leprán I, Mátyus P, Varró A, Papp JG. Antiarrhythmic and electrophysiological effects of GYKI-16638, a novel N-(phenoxyalkyl)-N-phenylalkylamine, in rabbits. Eur J Pharmacol 2000; 404:181-90. [PMID: 10980278 DOI: 10.1016/s0014-2999(00)00591-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The effect of N-[4-[2-N-methyl-N-[1-methyl-2-(2, 6-dimethylphenoxy)ethylamino]-ethyl]-phenyl]-methanesulfonamide. hydrochloride (GYKI-16638; 0.03 and 0.1 mg/kg, i.v.), a novel antiarrhythmic compound, was assessed and compared to that of D-sotalol (1 and 3 mg/kg, i.v.) on arrhythmias induced by 10 min of coronary artery occlusion and 10 min of reperfusion in anaesthetized rabbits. Also, its cellular electrophysiological effects were studied in rabbit right ventricular papillary muscle preparations and in rabbit single isolated ventricular myocytes. In anaesthetized rabbits, intravenous administration of 0.03 and 0.1 mg/kg GYKI-16638 and 1 and 3 mg/kg D-sotalol significantly increased survival during reperfusion (GYKI-16638: 82% and 77%, D-sotalol: 75% and 83% vs. 18% in controls, P<0.05, respectively). GYKI-16638 (0.1 mg/kg) significantly increased the number of animals that did not develop arrhythmias during reperfusion (46% vs. 0% in controls, P<0.05). In isolated rabbit right ventricular papillary muscle, 2 microM GYKI-16638, at 1 Hz stimulation frequency, lengthened the action potential duration at 50% and 90% repolarization (APD(50-90)) without influencing the resting membrane potential and action potential amplitude (APA). It decreased the maximal rate of depolarization (V(max)) in a use-dependent manner. This effect was statistically significant only at stimulation cycle lengths shorter than 700 ms. The offset kinetics of this V(max) block were relatively rapid, the corresponding time constant for recovery of V(max) was 328.2+/-65.0 ms. In patch-clamp experiments, performed in rabbit ventricular myocytes, 2 microM GYKI-16638 markedly depressed the rapid component of the delayed rectifier outward and moderately decreased the inward rectifier K(+) current without significantly altering the slow component of the delayed rectifier and transient outward K(+) currents. These results suggest that in rabbits, GYKI-16638 has an in vivo antiarrhythmic effect, comparable to that of D-sotalol, which can be best explained by its combined Class I/B and Class III actions.
Collapse
Affiliation(s)
- I Baczkó
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged and Research Unit of the Hungarian Academy of Sciences, Dóm tér 12, P.O. Box 427, H-6701, Szeged, Hungary
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Treatment of atrial fibrillation and paroxysmal supraventricular tachycardia with bidisomide. The Atrial Fibrillation Investigation with Bidisomide (AFIB) Investigators. Circulation 1997; 96:2625-32. [PMID: 9355903 DOI: 10.1161/01.cir.96.8.2625] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Atrial fibrillation and paroxysmal supraventricular tachycardia are common disorders of the heart rhythm for which antiarrhythmic drug therapy is commonly prescribed. The Atrial Fibrillation Investigation with Bidisomide (AFIB) study was a randomized, placebo-controlled clinical trial designed to accomplish three goals in a single protocol: (1) to determine the efficacy of the antiarrhythmic drug bidisomide in the treatment of these two arrhythmias; (2) to establish the appropriate dose range for bidisomide; and (3) to detect an adverse mortality effect of bidisomide if one were present in patients with atrial fibrillation. METHODS AND RESULTS In this clinical trial, 1227 patients with atrial fibrillation and 187 with paroxysmal supraventricular tachycardia were randomly assigned to bidisomide (200, 400, or 600 mg BID) or placebo; patient groups with each arrhythmia were analyzed separately. Symptomatic recurrences of atrial fibrillation and paroxysmal supraventricular tachycardia were documented with the use of transtelephonic ECG monitoring. The time to the first symptomatic arrhythmia recurrence was measured in each patient and compared among treatment groups. Among the atrial fibrillation patients, there was no significant difference in the time to first symptomatic recurrence between the placebo group and any of the three bidisomide treatment groups; the hazard ratios (placebo:treatment) were 1.19, 1.03, and 1.14 for bidisomide 200, 400, and 600 mg BID, respectively. Among paroxysmal supraventricular tachycardia patients, there was a similar lack of a significant treatment effect; the hazard ratios were 1.30, 1.93, and 1.59 for bidisomide 200, 400, and 600 mg BID, respectively. In the primary safety analysis of mortality, 3 of 493 patients taking placebo died, compared with 9 of 488 patients taking one of the two higher doses of bidisomide (P>.10). CONCLUSIONS Bidisomide in the doses tested did not have a clinically important antiarrhythmic effect. The AFIB study provided a novel clinical trial design to test antiarrhythmic drugs for both safety and efficacy.
Collapse
|