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Willcox A, Lee NT, Nandurkar HH, Sashindranath M. CD39 in the development and progression of pulmonary arterial hypertension. Purinergic Signal 2022; 18:409-419. [PMID: 35947229 PMCID: PMC9832216 DOI: 10.1007/s11302-022-09889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a devastating progressive disease characterised by pulmonary arterial vasoconstriction and vascular remodelling. Endothelial dysfunction has emerged as a contributing factor in the development of PAH. However, despite progress in the understanding of the pathophysiology of this disease, current therapies fail to impact upon long-term outcomes which remain poor in most patients. Recent observations have suggested the disturbances in the balance between ATP and adenosine may be integral to the vascular remodelling seen in PAH. CD39 is an enzyme important in regulating these nucleos(t)ides which may also provide a novel pathway to target for future therapies. This review summarises the role of adenosine signalling in the development and progression of PAH and highlights the therapeutic potential of CD39 for treatment of PAH.
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Affiliation(s)
- Abbey Willcox
- Australian Centre for Blood Diseases, Central Clinical School, Monash University and Alfred Health, Monash AMREP Building, Level 1, Walkway, via The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Natasha Ting Lee
- Australian Centre for Blood Diseases, Central Clinical School, Monash University and Alfred Health, Monash AMREP Building, Level 1, Walkway, via The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Harshal H Nandurkar
- Australian Centre for Blood Diseases, Central Clinical School, Monash University and Alfred Health, Monash AMREP Building, Level 1, Walkway, via The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Maithili Sashindranath
- Australian Centre for Blood Diseases, Central Clinical School, Monash University and Alfred Health, Monash AMREP Building, Level 1, Walkway, via The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
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Abstract
Pulmonary arterial hypertension (PAH) is a life‐threatening disease characterized by increased pulmonary arterial pressure and pulmonary vascular resistance, which result in an increase in afterload imposed onto the right ventricle, leading to right heart failure. Current therapies are incapable of reversing the disease progression. Thus, the identification of novel and potential therapeutic targets is urgently needed. An alteration of nucleotide‐ and nucleoside‐activated purinergic signaling has been proposed as a potential contributor in the pathogenesis of PAH. Adenosine‐mediated purinergic 1 receptor activation, particularly A2AR activation, reduces pulmonary vascular resistance and attenuates pulmonary vascular remodeling and right ventricle hypertrophy, thereby exerting a protective effect. Conversely, A2BR activation induces pulmonary vascular remodeling, and is therefore deleterious. ATP‐mediated P2X7R activation and ADP‐mediated activation of P2Y1R and P2Y12R play a role in pulmonary vascular tone, vascular remodeling, and inflammation in PAH. Recent studies have revealed a role of ectonucleotidase nucleoside triphosphate diphosphohydrolase, that degrades ATP/ADP, in regulation of pulmonary vascular remodeling. Interestingly, existing evidence that adenosine activates erythrocyte A2BR signaling, counteracting hypoxia‐induced pulmonary injury, and that ATP release is impaired in erythrocyte in PAH implies erythrocyte dysfunction as an important trigger to affect purinergic signaling for pathogenesis of PAH. The present review focuses on current knowledge on alteration of nucleot(s)ide‐mediated purinergic signaling as a potential disease mechanism underlying the development of PAH.
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Affiliation(s)
- Zongye Cai
- Division of Experimental Cardiology Department of Cardiology Erasmus MCUniversity Medical Center Rotterdam Rotterdam the Netherlands
| | - Ly Tu
- INSERM UMR_S 999Hôpital Marie Lannelongue Le Plessis-Robinson France.,School of Medicine Université Paris-Saclay Kremlin-Bicêtre France
| | - Christophe Guignabert
- INSERM UMR_S 999Hôpital Marie Lannelongue Le Plessis-Robinson France.,School of Medicine Université Paris-Saclay Kremlin-Bicêtre France
| | - Daphne Merkus
- Division of Experimental Cardiology Department of Cardiology Erasmus MCUniversity Medical Center Rotterdam Rotterdam the Netherlands.,Walter Brendel Center of Experimental Medicine LMU Munich Munich Germany.,German Center for Cardiovascular Research, Partner Site MunichMunich Heart Alliance Munich Germany
| | - Zhichao Zhou
- Division of Cardiology Department of Medicine Karolinska University HospitalKarolinska Institutet Stockholm Sweden
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Li Q, Dimopoulos K, Zhang C, Zhu Y, Liu Q, Gu H. Acute Effect of Inhaled Iloprost in Children with Pulmonary Arterial Hypertension Associated with Simple Congenital Heart Defects. Pediatr Cardiol 2018; 39:757-762. [PMID: 29426959 DOI: 10.1007/s00246-018-1818-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/17/2018] [Indexed: 11/29/2022]
Abstract
Inhaled prostacyclin analogue iloprost is currently utilized in adult patients with pulmonary arterial hypertension (PAH), but little information is available on its use in the pediatric population. This study evaluated the safety and acute haemodynamic effects of inhaled iloprost in children with PAH associated with congenital heart disease (CHD). Children with PAH-CHD who underwent cardiac catheterization and iloprost administration in our catheter laboratory between June 2007 and October 2015 were included. Iloprost was administered by atomization inhalation and changes in hemodynamic parameters were recorded. In total, 100 children with PAH-CHD were enrolled. Median age was 13 [1.5-18.0] years and 34% were male. A ventricular septal defect was present in 84%, a patent duct in 12%, a complete atrioventricular septal defect in 2%, and an isolated atrial septal defect in 2%. Pulmonary vascular resistance indexed (PVRI) was above 8 WU m2 in 96% and was above a third systemic (Rp/Rs > 0.33) in 97%. Iloprost was well tolerated in all patients. Following iloprost inhalation, mean pulmonary arterial pressure decreased from 78.4 ± 9.2 to 72.8 ± 10.8 mmHg (p < 0.01) and pulmonary-to-systemic blood flow ratio (Qp/Qs) increased from 1.12 ± 0.48 to 1.37 ± 0.63 (p < 0.01), with no change in cardiac index (Qs). PVRI decreased from 21.0 ± 9.0 to 16.9 ± 8.0 WU m2 (p < 0.01) following inhalation but 92% patients still had a PVRI > 8 WU m2 and 93% an Rp/Rs > 0.33. Acute inhalation of iloprost in children with PAH associated with CHD resulted in a significant improvement in hemodynamic parameters. Despite this, few patients achieve strict criteria of operability, underscoring the importance of early screening and timely repair of CHD.
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Affiliation(s)
- Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, 4th Floor, Cardiac Surgery Building, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, London, UK
| | - Chen Zhang
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, 4th Floor, Cardiac Surgery Building, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yan Zhu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, 4th Floor, Cardiac Surgery Building, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Qian Liu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, 4th Floor, Cardiac Surgery Building, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, 4th Floor, Cardiac Surgery Building, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Apitz C, Hansmann G, Schranz D. Hemodynamic assessment and acute pulmonary vasoreactivity testing in the evaluation of children with pulmonary vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart 2016; 102 Suppl 2:ii23-9. [PMID: 27053694 DOI: 10.1136/heartjnl-2014-307340] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/13/2015] [Indexed: 11/04/2022] Open
Abstract
Invasive assessment of haemodynamics (ventricular, pulmonary) and testing of acute vasoreactivity in the catheterisation laboratory remain the gold standard for the diagnosis of pulmonary hypertension (PH) and pulmonary hypertensive vascular disease. However, these measurements and the interpretation thereof are challenging due to the heterogeneous aetiology of PH in childhood and potentially confounding factors in the catheterisation laboratory. Patients with pulmonary arterial hypertension (PAH) associated with congenital heart disease who have a cardiovascular shunt need to undergo a completely different catheterisation approach than those with idiopathic PAH lacking an anatomical cardiovascular defect. Diagnostic cardiac catheterisation of children with suspected PH usually includes right and left heart catheterisation, particularly for the initial assessment (ie, at the time of diagnosis), and should be performed in experienced centres only. Here, we present graded consensus recommendations for the invasive evaluation of children with PH including those with pulmonary hypertensive vascular disease and/or ventricular dysfunction. Based on the limited published studies and our own experience we suggest a structured catheterisation protocol and two separate definitions of positive acute vasoreactivity testing (AVT): (1) AVT to assess prognosis and indication for specific PH therapy, and (2) AVT to assess operability of PAH associated with congenital heart disease. The protocol and the latter definitions may help in the systematic assessment of these patients and the interpretation of the obtained data. Beyond an accurate diagnosis in the individual patient, such a structured approach may allow systematic decision making for the initiation of a specific treatment and may assist in estimating disease progression and individual prognosis.
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Affiliation(s)
- Christian Apitz
- Division of Pediatric Cardiology, University Children's Hospital, Ulm, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Dietmar Schranz
- Pediatric Heart Centre, Justus-Liebig-University, Giessen, Germany
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Sandqvist A, Henrohn D, Egeröd H, Hedeland M, Wernroth L, Bondesson U, Schneede J, Wikström G. Acute vasodilator response to vardenafil and clinical outcome in patients with pulmonary hypertension. Eur J Clin Pharmacol 2015; 71:1165-73. [PMID: 26242227 DOI: 10.1007/s00228-015-1914-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Acute vasodilator testing is recommended in patients with pulmonary arterial hypertension to identify individuals who may benefit from long-term treatment with oral calcium channel blockers. The aim of this study was to investigate the use of vardenafil in acute vasoreactivity testing compared to adenosine. METHODS A total of 20 patients eligible for right heart catheterisation were enrolled. Acute vasoreactivity testing was carried out with intravenous (iv) adenosine (n = 18) followed by oral vardenafil (n = 20). Haemodynamic responses were recorded at baseline and after 60 min (vardenafil). Responders were defined according to consensus guideline criteria. RESULTS Both vardenafil and adenosine significantly decreased mean pulmonary arterial pressure (mPAP, p < 0.001 and p = 0.026, respectively) and pulmonary vascular resistance (p < 0.001 and p > 0.001, respectively), and significantly increased cardiac output (p = 0.001 and p = 0.005, respectively). Vardenafil reduced mPAP more than adenosine (p = 0.044), while adenosine resulted in higher responses of cardiac index (p = 0.009) and pulmonary arterial oxygen saturation (p = 0.042). Acute adverse reactions were common with adenosine, while no side effects were observed after a single oral dose vardenafil. Vardenafil identified five responders (out of 20), while adenosine identified three responders (out of 18). During a 7-year follow-up, vardenafil responders had significantly lower NT-proBNP levels compared to non-responders. CONCLUSIONS Vardenafil may be safely used for acute vasoreactivity testing in patients with PH. A single oral dose of vardenafil is better tolerated than iv adenosine and may identify additional responders who could benefit from long-term vasodilator treatment.
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Affiliation(s)
- Anna Sandqvist
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden.
| | - Dan Henrohn
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hanna Egeröd
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mikael Hedeland
- Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden
- Department of Medicinal Chemistry, Division of Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden
| | - Lisa Wernroth
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Ulf Bondesson
- Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden
- Department of Medicinal Chemistry, Division of Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Gerhard Wikström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Xiao JW, Zhu XY, Wang QG, Zhang DZ, Cui CS, Zhang P, Chen HY, Meng LL. Acute Effects of Rho-Kinase Inhibitor Fasudil on Pulmonary Arterial Hypertension in Patients With Congenital Heart Defects. Circ J 2015; 79:1342-8. [DOI: 10.1253/circj.cj-14-1015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jia-wang Xiao
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Xian-yang Zhu
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Qi-guang Wang
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Duan-zhen Zhang
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Chun-Sheng Cui
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Po Zhang
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Huo-yuan Chen
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
| | - Li-li Meng
- Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command
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Zhang DZ, Zhu XY, Lv B, Cui CS, Han XM, Sheng XT, Wang QG, Zhang P. Trial Occlusion to Assess the Risk of Persistent Pulmonary Arterial Hypertension After Closure of a Large Patent Ductus Arteriosus in Adolescents and Adults With Elevated Pulmonary Artery Pressure. Circ Cardiovasc Interv 2014; 7:473-81. [PMID: 25097200 DOI: 10.1161/circinterventions.113.001135] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Duan-zhen Zhang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xian-yang Zhu
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Bei Lv
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Chun-sheng Cui
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xiu-min Han
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xiao-tang Sheng
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Qi-guang Wang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Po Zhang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
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Simsic J, Phelps C, Yates A, Galantowicz M. Management strategies after cardiac surgery in an infant with human rhinovirus. Pediatr Cardiol 2014; 34:1922-4. [PMID: 22854832 DOI: 10.1007/s00246-012-0459-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
This report presents management strategies after cardiopulmonary bypass surgery for an infant with community-acquired rhinovirus bronchiolitis. The case report emphasizes human rhinovirus as a lower respiratory pathogen, the difficulty treating the complications of human rhinovirus for an infant with cyanotic congenital heart disease after cardiac surgery, and the importance of preoperative evaluation for this respiratory infection in high-risk infants before cardiac surgery.
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Affiliation(s)
- Janet Simsic
- Department of Cardiology, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA,
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A welcome to the new journal, International Journal of Cardiology - Heart and Vessels (IJC-H + V). INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2013; 1:1-10. [PMID: 29450152 PMCID: PMC5801079 DOI: 10.1016/j.ijchv.2013.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 11/20/2022]
Abstract
A new journal has been launched: IJC - Heart and Vessels [1]. It builds upon the success of the main journal International Journal of Cardiology. As an introduction to the new journal we will be publishing a series of summaries of the topics to be covered, highlighting the most important papers in the field that have been published recently in the main journal, International Journal of Cardiology. This article describes a topic review of congenital heart disease. IJC has become one of the most important sources of quality papers in this field and many excellent publications have been published in the main journal. The expansion of space occasioned by the launch of IJC - Heart and Vessels will allow us to publish more high quality papers in the expanding field of congenital heart disease.
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Caruso M, Alamo A, Crisafulli E, Raciti C, Fisichella A, Polosa R. Adenosine signaling pathways as potential therapeutic targets in respiratory disease. Expert Opin Ther Targets 2013; 17:761-72. [PMID: 23642090 DOI: 10.1517/14728222.2013.795220] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Adenosine receptors (ARs) and their differential pattern of expression modulate a series of pleiotropic activities that are known to contribute to the control of inflammation, remodeling, and tissue repair. Consequently, pharmacological manipulation of adenosine signaling pathway is of great interest and is currently exploited as a therapeutic target for a number of respiratory diseases with several molecules with agonist and antagonist activities against known ARs being developed for the treatment of different conditions of the respiratory system. AREAS COVERED Herein, we will review the rational basis leading to the development of novel therapies for asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and cystic fibrosis. Their most recent clinical development will be also discussed. EXPERT OPINION Advances in our understanding of the pathogenetic role of adenosine in respiratory diseases may be soon translated into effective treatment options. In consideration of the complex interplay driven by the different pattern of receptor distribution and/or affinity of the four known AR subtypes in specific cell types at different stages of the disease, it is likely that combination of selective antagonist/agonists for different AR subtypes will be required to obtain reasonable clinical efficacy. Alternatively, controlling the factors involved in driving adenosine concentrations in the tissue may be also of great significance.
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Affiliation(s)
- Massimo Caruso
- University of Catania-AOU Policlinico-V. Emanuele, Institute of Internal Medicine and Clinical Immunology, Department of Clinical and Molecular Bio-Medicine, Catania, Italy.
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Grignola JC, Domingo E, Aguilar R, Vázquez M, López-Messeguer M, Bravo C, Roman A. Acute absolute vasodilatation is associated with a lower vascular wall stiffness in pulmonary arterial hypertension. Int J Cardiol 2013; 164:227-31. [DOI: 10.1016/j.ijcard.2011.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 05/19/2011] [Accepted: 07/03/2011] [Indexed: 10/18/2022]
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Coats AJS. Reply to the Hong-Lin Chen article on CONSORT (2010) recommendations. Int J Cardiol 2012; 162:4-5. [PMID: 23138012 DOI: 10.1016/j.ijcard.2012.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/20/2012] [Indexed: 10/27/2022]
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Mulligan C, Beghetti M. Inhaled iloprost for the control of acute pulmonary hypertension in children: a systematic review. Pediatr Crit Care Med 2012; 13:472-80. [PMID: 21926655 DOI: 10.1097/pcc.0b013e31822f192b] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Inhaled iloprost is attracting growing interest as a potential alternative and/or adjuvant to inhaled nitric oxide in the management of pediatric pulmonary hypertension in the acute and intensive care settings. However, there are currently no formal evidence-based guidelines regarding the use of inhaled iloprost in children with pulmonary hypertension. The aim of this systematic review is to assess the literature concerning the use of inhaled iloprost in children with pulmonary hypertension in the acute setting. DATA SOURCES Studies were identified from PubMed and Embase. Internal literature databases and recent congress abstracts (2009 onward) were also searched for relevant publications. STUDY SELECTION Studies were included if they examined the use of inhaled iloprost in children with pulmonary hypertension in an acute or intensive care setting. DATA EXTRACTION AND SYNTHESIS Twenty-eight studies were included in the review. The majority were case studies or case series (n = 17), and in total, the 28 studies represented the treatment of 195 children with iloprost. Iloprost was most frequently studied in children undergoing cardiac surgery (as a bridge to surgery and postoperatively), in children undergoing acute pulmonary vasoreactivity testing, and in neonates with persistent pulmonary hypertension of the newborn. The results of the included studies suggested that inhaled iloprost may have a diverse role in the acute treatment of pediatric pulmonary hypertension and that its acute effects are similar to those of inhaled nitric oxide. However, the iloprost dose was not consistently reported and varied greatly between studies, and several different administration devices were used. CONCLUSIONS Inhaled iloprost may be useful in the acute treatment of children and neonates with pulmonary hypertension, but clinical data are scarce, and the appropriate dosing of iloprost in different scenarios is uncertain. Well-designed prospective clinical trials are needed.
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Affiliation(s)
- Claire Mulligan
- Research Evaluation Unit, Oxford PharmaGenesis Limited, Oxford, U.K
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Reporting in randomized trials published in International Journal of Cardiology in 2011 compared to the recommendations made in CONSORT 2010. Int J Cardiol 2012; 160:208-10. [PMID: 22738783 DOI: 10.1016/j.ijcard.2012.06.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/08/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022]
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