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Sarkar T, Moinuddin SM, Isbatan A, Chen J, Mann D, Ahsan F. Intratracheally Administered Peptide-Modified Lipid Admixture Containing Fasudil and/or DETA NONOate Ameliorates Various Pathologies of Pulmonary Arterial Hypertension. Pharmaceuticals (Basel) 2023; 16:1656. [PMID: 38139783 PMCID: PMC10747237 DOI: 10.3390/ph16121656] [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: 11/03/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
This study examined the therapeutic potential of a combination therapy using fasudil, a Rho-kinase inhibitor, and DETA NONOate (DN), a nitric oxide donor, delivered as a lipid admixture modified with a cyclic homing peptide known as CAR (CAR-lipid mixture) for the treatment of pulmonary arterial hypertension (PAH). CAR-lipid mixtures were initially prepared via a thin-film hydration method and then combined with fasudil, DN, or a mixture of both. The therapeutic efficacy of this drug-laden lipid mixture was evaluated in a Sugen/Hypoxia (Su/Hx) rat model of PAH by measuring RV systolic pressure (RVSP), mean pulmonary arterial pressure (mPAP), Fulton indices, and assessing right ventricular (RV) functions, as well as evaluating pulmonary vascular morphology. Rats that received no treatment exhibited increases in RVSP, mPAP, Fulton indices, and changes in RV functional parameters. However, the treatment with the CAR-lipid mixture containing either fasudil or DN or a combination of both led to a decline in mPAP, RVSP, and Fulton indices compared to saline-treated rats. Similarly, rats that received these treatments showed concurrent improvement in various echocardiographic parameters such as pulmonary acceleration time (PAT), tricuspid annular plane systolic excursion (TAPSE), and ventricular free wall thickness (RVFWT). A significant decrease in the wall thickness of pulmonary arteries larger than 100 µm was observed with the combination therapy. The findings reveal that fasudil, DN, and their combination in a CAR-modified lipid mixture improved pulmonary hemodynamics, RV functions, and pathological alterations in the pulmonary vasculature. This study underscores the potential of combination therapy and targeted drug delivery in PAH treatment, laying the groundwork for future investigations into the optimization of these treatments, their long-term safety and efficacy, and the underlying mechanism of action of the proposed therapy.
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Affiliation(s)
- Tanoy Sarkar
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Sakib M. Moinuddin
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Ayman Isbatan
- Cardiovascular Research Center, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jiwang Chen
- Cardiovascular Research Center, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Medicine, Section of Pulmonary, Critical Care Medicine, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - David Mann
- Vascular BioSciences, Goleta, CA 93117, USA
| | - Fakhrul Ahsan
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
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Alexandre A, Furtado I, Carvalho L, Gonçalves F, Melo A, Alves J, Santos M, Reis A. Transitioning intravenous epoprostenol to oral selexipag in idiopathic pulmonary arterial hypertension: a case report. ESC Heart Fail 2023; 10:2722-2727. [PMID: 37336527 PMCID: PMC10375174 DOI: 10.1002/ehf2.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/22/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
Intravenous (i.v.) prostacyclin is the cornerstone treatment in high-risk pulmonary arterial hypertension (PAH) patients. Selexipag is an orally available prostacyclin receptor agonist. Limited data are available regarding the feasibility of transitioning from i.v. epoprostenol to selexipag. A 50-year-old woman with idiopathic PAH was diagnosed in a World Health Organization (WHO) Functional Class (FC) IV. She improved with upfront triple combination therapy, including i.v. epoprostenol. Over 2 years of follow-up, the patient remained at low risk and expressed strong preference towards oral therapies. After careful risk-benefit clinical consideration, she was transitioned from i.v. epoprostenol to selexipag. Selexipag was started at dosage of 200 μg twice daily (b.i.d.) and titrated up to 1600 μg b.i.d. over 8 weeks (up-titration of 200 μg b.i.d. every week). Simultaneously, i.v. epoprostenol was down-titrated 3.0 ng/kg/min every week from a dosage of 27.5 ng/kg/min. The transition occurred under strict medical surveillance and was well tolerated. One year after discontinuation of epoprostenol, the patient remains in WHO FC I and has no signs of clinical deterioration. Although not generalizable to most PAH patients, this case highlights that a carefully planned transition from epoprostenol to selexipag is feasible in selected low-risk patients within a shared medical decision-making framework.
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Affiliation(s)
- André Alexandre
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
| | - Inês Furtado
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- Department of Internal MedicineCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
| | - Luísa Carvalho
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- Department of Internal MedicineCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
| | - Fabienne Gonçalves
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- Department of Internal MedicineCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- ICBAS—School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Alzira Melo
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
| | - Joana Alves
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
| | - Mário Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- ICBAS—School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- ITR—Laboratory for Integrative and Translational Research in Population HealthPortoPortugal
- UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Abílio Reis
- Pulmonary Vascular Disease UnitCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- Department of Internal MedicineCentro Hospitalar Universitário de Santo António (CHUdSA)PortoPortugal
- ICBAS—School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
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