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Premuzic Mestrovic I, Smoday IM, Kalogjera L, Krezic I, Zizek H, Vranes H, Vukovic V, Oroz K, Skorak I, Brizic I, Hriberski K, Novosel L, Kavelj I, Barisic I, Beketic Oreskovic L, Zubcic S, Strbe S, Mestrovic T, Pavic P, Staresinic M, Skrtic A, Boban Blagaic A, Seiwerth S, Sikiric P. Antiarrhythmic Sotalol, Occlusion/Occlusion-like Syndrome in Rats, and Stable Gastric Pentadecapeptide BPC 157 Therapy. Pharmaceuticals (Basel) 2023; 16:977. [PMID: 37513889 PMCID: PMC10383471 DOI: 10.3390/ph16070977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
We focused on the first demonstration that antiarrhythmics, particularly class II and class III antiarrhythmic and beta-blocker sotalol can induce severe occlusion/occlusion-like syndrome in rats. In this syndrome, as in similar syndromes with permanent occlusion of major vessels, peripheral and central, and other similar noxious procedures that severely disable endothelium function, the stable gastric pentadecapeptide BPC 157-collateral pathways activation, was a resolving therapy. After a high dose of sotalol (80 mg/kg intragastrically) in 180 min study, there were cause-consequence lesions in the brain (swelling, intracerebral hemorrhage), congestion in the heart, lung, liver, kidney, and gastrointestinal tract, severe bradycardia, and intracranial (superior sagittal sinus), portal and caval hypertension, and aortal hypotension, and widespread thrombosis, peripherally and centrally. Major vessels failed (congested inferior caval and superior mesenteric vein, collapsed azygos vein). BPC 157 therapy (10 µg, 10 ng/kg given intragastrically at 5 min or 90 min sotalol-time) effectively counteracted sotalol-occlusion/occlusion-like syndrome. In particular, eliminated were heart dilatation, and myocardial congestion affecting coronary veins and arteries, as well as myocardial vessels; eliminated were portal and caval hypertension, lung parenchyma congestion, venous and arterial thrombosis, attenuated aortal hypotension, and centrally, attenuated intracranial (superior sagittal sinus) hypertension, brain lesions and pronounced intracerebral hemorrhage. Further, BPC 157 eliminated and/or markedly attenuated liver, kidney, and gastrointestinal tract congestion and major veins congestion. Therefore, azygos vein activation and direct blood delivery were essential for particular BPC 157 effects. Thus, preventing such and similar events, and responding adequately when that event is at risk, strongly advocates for further BPC 157 therapy.
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Affiliation(s)
| | - Ivan Maria Smoday
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Kalogjera
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Krezic
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Helena Zizek
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Hrvoje Vranes
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Vlasta Vukovic
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Katarina Oroz
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Skorak
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Brizic
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Klaudija Hriberski
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Novosel
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Ivana Kavelj
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Barisic
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | | | - Slavica Zubcic
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Sanja Strbe
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Mestrovic
- Department of Surgery, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Predrag Pavic
- Department of Surgery, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Mario Staresinic
- Department of Surgery, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Anita Skrtic
- Department of Pathology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine University of Zagreb, 10000 Zagreb, Croatia
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Cabo C. Multichannel modulation of depolarizing and repolarizing ion currents increases the positive rate-dependent action potential prolongation. Physiol Rep 2023; 11:e15683. [PMID: 37144560 PMCID: PMC10161211 DOI: 10.14814/phy2.15683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Abstract
Prolongation of the action potential duration (APD) could prevent reentrant arrhythmias if prolongation occurs at the fast excitation rates of tachycardia with minimal prolongation at slow excitation rates (i.e., if prolongation is positive rate-dependent). APD prolongation by current anti-arrhythmic agents is either reverse (larger APD prolongation at slow rates than at fast rates) or neutral (similar APD prolongation at slow and fast rates), which may not result in an effective anti-arrhythmic action. In this report we show that, in computer models of the human ventricular action potential, the combined modulation of both depolarizing and repolarizing ion currents results in a stronger positive rate-dependent APD prolongation than modulation of repolarizing potassium currents. A robust positive rate-dependent APD prolongation correlates with an acceleration of phase 2 repolarization and a deceleration of phase 3 repolarization, which leads to a triangulation of the action potential. A positive rate-dependent APD prolongation decreases the repolarization reserve with respect to control, which can be managed by interventions that prolong APD at fast excitation rates and shorten APD at slow excitation rates. For both computer models of the action potential, ICaL and IK1 are the most important ion currents to achieve a positive rate-dependent APD prolongation. In conclusion, multichannel modulation of depolarizing and repolarizing ion currents, with ion channel activators and blockers, results in a robust APD prolongation at fast excitation rates, which should be anti-arrhythmic, while minimizing APD prolongation at slow heart rates, which should reduce pro-arrhythmic risks.
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Affiliation(s)
- Candido Cabo
- Department of Computer Systems, New York City College of Technology, Doctoral Program in Computer Science, Graduate Center, City University of New York, New York City, New York, USA
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Cabo C. Positive rate-dependent action potential prolongation by modulating potassium ion channels. Physiol Rep 2022; 10:e15356. [PMID: 35748083 PMCID: PMC9226816 DOI: 10.14814/phy2.15356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Pharmacological agents that prolong action potential duration (APD) to a larger extent at slow rates than at the fast excitation rates typical of ventricular tachycardia exhibit reverse rate dependence. Reverse rate dependence has been linked to the lack of efficacy of class III agents at preventing arrhythmias because the doses required to have an antiarrhythmic effect at fast rates may have pro-arrhythmic effects at slow rates due to an excessive APD prolongation. In this report, we show that, in computer models of the ventricular action potential, APD prolongation by accelerating phase 2 repolarization (by increasing IKs ) and decelerating phase 3 repolarization (by blocking IKr and IK1 ) results in a robust positive rate dependence (i.e., larger APD prolongation at fast rates than at slow rates). In contrast, APD prolongation by blocking a specific potassium channel type results in reverse rate dependence or a moderate positive rate dependence. Interventions that result in a strong positive rate dependence tend to decrease the repolarization reserve because they require substantial IK1 block. However, limiting IK1 block to ~50% results in a strong positive rate dependence with moderate decrease in repolarization reserve. In conclusion, the use of a combination of IKs activators and IKr and IK1 blockers could result in APD prolongation that potentially maximizes antiarrhythmic effects (by maximizing APD prolongation at fast excitation rates) and minimizes pro-arrhythmic effects (by minimizing APD prolongation at slow excitation rates).
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Affiliation(s)
- Candido Cabo
- Department of Computer Systems, New York City College of Technology, Doctoral Program in Computer Science, Graduate Center, City University of New York, New York, New York, USA
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Sinagra G, Corrà U, Contini M, Magrì D, Paolillo S, Perrone Filardi P, Sciomer S, Badagliacca R, Agostoni P. Choosing among β-blockers in heart failure patients according to β-receptors' location and functions in the cardiopulmonary system. Pharmacol Res 2020; 156:104785. [PMID: 32224252 DOI: 10.1016/j.phrs.2020.104785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
Several large clinical trials showed a favorable effect of β-blocker treatment in patients with chronic heart failure (HF) as regards overall mortality, cardiovascular mortality, and hospitalizations. Indeed, the use of β-blockers is strongly recommended by current international guidelines, and it remains a cornerstone in the pharmacological treatment of HF. Although different types of β-blockers are currently approved for HF therapy, possible criteria to choose the best β-blocking agent according to HF patients' characteristics and to β-receptors' location and functions in the cardiopulmonary system are still lacking. In such a context, a growing body of literature shows remarkable differences between β-blocker types (β1-selective blockers versus β1-β2 blockers) with respect to alveolar-capillary gas diffusion and chemoreceptor response in HF patients, both factors able to impact on quality of life and, most likely, on prognosis. This review suggests an original algorithm for choosing among the currently available β-blocking agents based on the knowledge of cardiopulmonary pathophysiology. Particularly, starting from lung physiology and from some experimental models, it focuses on the mechanisms underlying lung mechanics, chemoreceptors, and alveolar-capillary unit impairment in HF. This paper also remarks the significant benefit deriving from the correct use of the different β-blockers in HF patients through a brief overview of the most important clinical trials.
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Affiliation(s)
- Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, Veruno Institute, Veruno, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | | | - Susanna Sciomer
- Dipartimento Di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Roberto Badagliacca
- Dipartimento Di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic Ventricular Tachycardia. J Emerg Med 2017; 52:484-492. [DOI: 10.1016/j.jemermed.2016.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/26/2016] [Accepted: 09/05/2016] [Indexed: 11/21/2022]
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Abstract
Sotalol is effective for treating atrial fibrillation (AF), ventricular tachycardia, premature ventricular contractions, and supraventricular tachycardia. Racemic (DL) sotalol inhibits the rapid component of the delayed rectifier potassium current. There is a near linear relationship between sotalol dosage and QT interval prolongation. However, in dose ranging trials in patients with AF, low-dose sotalol was not more effective than placebo. Orally administered sotalol has a bioavailability of nearly 100%. The only significant drug interactions are the need to avoid or limit use of concomitant drugs that cause QT prolongation, bradycardia, and/or hypotension.
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Affiliation(s)
- John Alvin Kpaeyeh
- Division of Cardiology, Department of Medicine, Tourville Arrhythmia Center, Medical University of South Carolina, 114 Doughty Street, MSC 592, Charleston, SC 29425-5920, USA
| | - John Marcus Wharton
- Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Tourville Arrhythmia Center, Medical University of South Carolina, 114 Doughty Street, BM 216, MSC 592, Charleston, SC 29425-5920, USA.
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Crotty Alexander LE, Marsh BJ, Timmer AM, Lin AE, Zainabadi K, Czopik A, Guarente L, Nizet V. Myeloid cell sirtuin-1 expression does not alter host immune responses to Gram-negative endotoxemia or Gram-positive bacterial infection. PLoS One 2013; 8:e84481. [PMID: 24386389 PMCID: PMC3873454 DOI: 10.1371/journal.pone.0084481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/14/2013] [Indexed: 11/20/2022] Open
Abstract
The role of sirtuin-1 (SIRT1) in innate immunity, and in particular the influence of SIRT1 on antimicrobial defense against infection, has yet to be reported but is important to define since SIRT1 inhibitors are being investigated as therapeutic agents in the treatment of cancer, Huntington’s disease, and autoimmune diseases. Given the therapeutic potential of SIRT1 suppression, we sought to characterize the role of SIRT1 in host defense. Utilizing both pharmacologic methods and a genetic knockout, we demonstrate that SIRT1 expression has little influence on macrophage and neutrophil antimicrobial functions. Myeloid SIRT1 expression does not change mortality in gram-negative toxin-induced shock or gram-positive bacteremia, suggesting that therapeutic suppression of SIRT1 may be done safely without suppression of myeloid cell-specific immune responses to severe bacterial infections.
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Affiliation(s)
- Laura E Crotty Alexander
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America ; Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Brenda J Marsh
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America ; Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Anjuli M Timmer
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Ann E Lin
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Kayvan Zainabadi
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Agnieszka Czopik
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Leonard Guarente
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Victor Nizet
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America ; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, United States of America
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Zhao G, Serpllion S, Shryock J, Messina E, Xu X, Ochoa M, Belardinelli L, Hintze TH. Regadenoson, a novel pharmacologic stress agent for use in myocardial perfusion imaging, does not have a direct effect on the QT interval in conscious dogs. J Cardiovasc Pharmacol 2008; 52:467-73. [PMID: 19033827 PMCID: PMC5774219 DOI: 10.1097/fjc.0b013e31818e035b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our goal was to determine the effect of regadenoson (a novel A2A adenosine receptor agonist) on the QT interval in conscious dogs. Sixteen mongrel dogs were chronically instrumented for measurements of blood pressure and ECG. Regadenoson (2.5, 5, and 10 microg/kg, IV) caused a dose-dependent QT interval shortening (DeltaQT: 14 +/- 3, 24 +/- 5, and 27 +/- 5 ms, mean +/- SEM; n = 7 to 11; all P < 0.05) associated with significant increases in HR (Peak HR: 114 +/- 9, 125 +/- 6, and 144 +/- 7 bpm). Atrial pacing (135, 150, and 165 bpm) also caused a frequency-dependent shortening of the QT interval (DeltaQT: 15 +/- 3, 22 +/- 3, and 39 +/- 5 ms; n = 6 to 7; all P < 0.05). Regadenoson- and pacing-induced shortenings in the QT interval were significantly correlated with the R-R interval (r = 0.67 and 0.8, both P < 0.05). Regadenoson at 5 and 10 microg/kg did not cause a significant change in HR or QT interval either during atrial pacing at 165 bpm or after administration of propranolol and atropine to prevent HR from changing or after treatment of dogs with hexamethonium to block autonomic ganglia. Regadenoson (5 to 10 microg/kg) caused no significant changes of QT interval in the heart in which HR was kept constant via physiological or pharmacological procedures, indicating that regadenoson has no direct effect on the QT interval.
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Affiliation(s)
- Gong Zhao
- Department of Pharmacology, CV Therapeutics, Inc., Palo Alto, California 94304, USA.
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Patterson E, Scherlag BJ, Lazzara R, Garrison GL, Berlin KD. Electrophysiologic Actions of d,l-Sotalol and GLG-V-13 in Ischemically Injured Canine Epicardium. J Cardiovasc Pharmacol 2007; 50:304-13. [PMID: 17878760 DOI: 10.1097/fjc.0b013e3180ca959e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The electrophysiologic actions of the class III antiarrhythmic agents, GLG-V-13 and d,l-sotalol, were examined in superfused normal and ischemically injured epicardium. Both drugs produced concentration and reverse-use dependent prolongation of the action potential duration in normal myocardium without altering resting potential, action potential amplitude, or Vmax. Both drugs increased the slope of restitution curves in normal epicardium but prevented action potential alternans at short cycle lengths. The response of superfused ischemically injured left ventricular epicardium to drug 4 days after coronary artery ligation was determined by the extent of ischemic injury, with no electrophysiologic changes produced within epicardial cells characterized by prominent action potential shortening and no further action potential shortening with pacing. Cells demonstrating less severe injury (as evidenced by less severely depressed action potential amplitudes, Vmax, and action potential durations) retained a limited ability to respond to drug administration with action potential prolongation. A concentration-dependent, increased disparity of action potential duration was observed concurrent with the ability of single premature stimuli to induce monomorphic tachycardia. The present data demonstrate a variable response of ischemically injured canine epicardial cells to action potential prolongation with GLG-V-13 and d,l-sotalol, facilitating localized reentry in vitro, despite a failure of the same drugs to facilitate reentrant tachycardia in vivo.
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Affiliation(s)
- Eugene Patterson
- University of Oklahoma Health Sciences Center, Oklahoma State University, Stillwater, OK, USA.
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Affiliation(s)
- Spyros Kokolis
- Downstate Medical Center, State University of New York, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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