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Shizukuda Y, Rosing DR. Hereditary hemochromatosis with homozygous C282Y HFE mutation: possible clinical model to assess effects of elevated reactive oxygen species on the development of cardiovascular disease. Mol Cell Biochem 2024; 479:617-627. [PMID: 37133674 DOI: 10.1007/s11010-023-04726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
Hereditary hemochromatosis with the homozygous C282Y HFE mutation (HH-282H) is a genetic condition which causes iron overload (IO) and elevated reactive oxygen species (ROS) secondary to the IO. Interestingly, even after successful iron removal therapy, HH-282H subjects demonstrate chronically elevated ROS. Raised ROS are also associated with the development of multiple cardiovascular diseases and HH-282H subjects may be at risk to develop these complications. In this narrative review, we consider HH-282H subjects as a clinical model for assessing the contribution of elevated ROS to the development of cardiovascular diseases in subjects with fewer confounding clinical risk factors as compared to other disease conditions with high ROS. We identify HH-282H subjects as a potentially unique clinical model to assess the impact of chronically elevated ROS on the development of cardiovascular disease and to serve as a clinical model to detect effective interventions for anti-ROS therapy.
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Affiliation(s)
- Yukitaka Shizukuda
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
- Division of Cardiology, Department of Internal Medicine, Cincinnati VA Medical Center, Cincinnati, OH, 45220, USA.
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA.
| | - Douglas R Rosing
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
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2
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Kulesza T, Typiak M, Rachubik P, Rogacka D, Audzeyenka I, Saleem MA, Piwkowska A. Pit 1 transporter (SLC20A1) as a key factor in the NPP1-mediated inhibition of insulin signaling in human podocytes. J Cell Physiol 2023; 238:1921-1936. [PMID: 37269459 DOI: 10.1002/jcp.31051] [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: 03/23/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
Podocytes are crucially involved in blood filtration in the glomerulus. Their proper function relies on efficient insulin responsiveness. The insulin resistance of podocytes, defined as a reduction of cell sensitivity to this hormone, is the earliest pathomechanism of microalbuminuria that is observed in metabolic syndrome and diabetic nephropathy. In many tissues, this alteration is mediated by the phosphate homeostasis-controlling enzyme nucleotide pyrophosphatase/phosphodiesterase 1 (NPP1). By binding to the insulin receptor (IR), NPP1 inhibits downstream cellular signaling. Our previous research found that hyperglycemic conditions affect another protein that is involved in phosphate balance, type III sodium-dependent phosphate transporter 1 (Pit 1). In the present study, we evaluated the insulin resistance of podocytes after 24 h of incubation under hyperinsulinemic conditions. Thereafter, insulin signaling was inhibited. The formation of NPP1/IR complexes was observed at that time. A novel finding in the present study was our observation of an interaction between NPP1 and Pit 1 after the 24 h stimulation of podocytes with insulin. After downregulation of the SLC20A1 gene, which encodes Pit 1, we established insulin resistance in podocytes that were cultured under native conditions, manifested as a lack of intracellular insulin signaling and the inhibition of glucose uptake via the glucose transporter type 4. These findings suggest that Pit 1 might be a major factor that participates in the NPP1-mediated inhibition of insulin signaling.
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Affiliation(s)
- Tomasz Kulesza
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
| | - Marlena Typiak
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
- Department of General and Medical Biochemistry, Faculty of Biology, University of Gdansk, Gdansk, Poland
| | - Patrycja Rachubik
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
| | - Dorota Rogacka
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
- Department of Molecular Biotechnology, Faculty of Chemistry, University of Gdansk, Gdansk, Poland
| | - Irena Audzeyenka
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
- Department of Molecular Biotechnology, Faculty of Chemistry, University of Gdansk, Gdansk, Poland
| | | | - Agnieszka Piwkowska
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
- Department of Molecular Biotechnology, Faculty of Chemistry, University of Gdansk, Gdansk, Poland
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Rogacka D, Rachubik P, Audzeyenka I, Szrejder M, Kulesza T, Myślińska D, Angielski S, Piwkowska A. Enhancement of cGMP-dependent pathway activity ameliorates hyperglycemia-induced decrease in SIRT1-AMPK activity in podocytes: Impact on glucose uptake and podocyte function. BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR CELL RESEARCH 2022; 1869:119362. [PMID: 36152759 DOI: 10.1016/j.bbamcr.2022.119362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/01/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Hyperglycemia significantly decreases 3',5'-cyclic guanosine monophosphate (cGMP)-dependent pathway activity in the kidney. A well-characterized downstream signaling effector of cGMP is cGMP-dependent protein kinase G (PKG), exerting a wide range of downstream effects, including vasodilation and vascular smooth muscle cells relaxation. In podocytes that are exposed to high glucose concentrations, crosstalk between the protein deacetylase sirtuin 1 (SIRT1) and adenosine monophosphate-dependent protein kinase (AMPK) decreased, attenuating insulin responsiveness and impairing podocyte function. The present study examined the effect of enhancing cGMP-dependent pathway activity on SIRT1-AMPK crosstalk in podocytes under hyperglycemic conditions. We found that enhancing cGMP-dependent pathway activity using a cGMP analog was associated with increases in SIRT1 protein levels and activity, with a concomitant increase in the degree of AMPK phosphorylation. The beneficial effects of enhancing cGMP-dependent pathway activity on SIRT1-AMPK crosstalk also included improvements in podocyte function. Based on our findings, we postulate an important role for SIRT1-AMPK crosstalk in the regulation of albumin permeability in hyperglycemia that is strongly associated with activity of the cGMP-dependent pathway.
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Affiliation(s)
- Dorota Rogacka
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland; Department of Molecular Biotechnology, Faculty of Chemistry, University of Gdansk, Gdansk, Poland.
| | - Patrycja Rachubik
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
| | - Irena Audzeyenka
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland; Department of Molecular Biotechnology, Faculty of Chemistry, University of Gdansk, Gdansk, Poland
| | - Maria Szrejder
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
| | - Tomasz Kulesza
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
| | - Dorota Myślińska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdansk, Gdansk, Poland
| | - Stefan Angielski
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland
| | - Agnieszka Piwkowska
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Gdansk, Poland; Department of Molecular Biotechnology, Faculty of Chemistry, University of Gdansk, Gdansk, Poland
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Chang TT, Chen JW. Potential Impacts of Hydralazine as a Novel Antioxidant on Cardiovascular and Renal Disease-Beyond Vasodilation and Blood Pressure Lowering. Antioxidants (Basel) 2022; 11:2224. [PMID: 36421409 PMCID: PMC9686999 DOI: 10.3390/antiox11112224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 10/04/2023] Open
Abstract
Hydralazine is a traditional antihypertensive drug that was developed several decades ago. Its most well-known effect is blood pressure lowering by arterial vasodilation. While mainly used an adjunct treatment for clinical hypertension or chronic heart failure, this old drug has also shown potential as a repurposing drug for the atherosclerosis vascular disease and various kidney diseases. Recent experimental studies suggest that hydralazine exerts antioxidative, anti-apoptotic, and HIF-1α stabilization effects for angiogenesis and vascular protection. Hydralazine also exerts reno-protective effects via its antioxidation, DNA demethylation, and anti-inflammation abilities. The above evidence provides advanced rationales for new applications of this drug beyond blood pressure lowering and arterial vasodilation. Here, we summarized the recent experimental advances in the use of hydralazine for either a vascular disease or kidney diseases, or both. Given the wide populations of people with cardiovascular and/or kidney diseases, future studies are worth validating the potential impacts of hydralazine on the clinical outcomes in selected patients.
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Affiliation(s)
- Ting-Ting Chang
- Department and Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Jaw-Wen Chen
- Department and Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Larkin BP, Nguyen LT, Hou M, Glastras SJ, Chen H, Faiz A, Chen J, Wang R, Pollock CA, Saad S. Low-dose hydralazine reduces albuminuria and glomerulosclerosis in a mouse model of obesity-related chronic kidney disease. Diabetes Obes Metab 2022; 24:1939-1949. [PMID: 35635331 PMCID: PMC9544807 DOI: 10.1111/dom.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/09/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
AIM To determine, using a mouse model of obesity, whether low-dose hydralazine prevents obesity-related chronic kidney disease (CKD). METHODS From 8 weeks of age, male C57BL/6 mice received a high-fat diet (HFD) or chow, with or without low-dose hydralazine (25 mg/L) in drinking water, for 24 weeks. Biometric and metabolic variables, renal function and structural changes, renal global DNA methylation, DNA methylation profile and markers of renal fibrosis, injury, inflammation and oxidative stress were assessed. RESULTS The HFD-fed mice developed obesity, with glucose intolerance, hyperinsulinaemia and dyslipidaemia. Obesity increased albuminuria and glomerulosclerosis, which were significantly ameliorated by low-dose hydralazine in the absence of a blood pressure-lowering effect. Obesity increased renal global DNA methylation and this was attenuated by low-dose hydralazine. HFD-induced changes in methylation of individual loci were also significantly reversed by low-dose hydralazine. Obese mice demonstrated increased markers of kidney fibrosis, inflammation and oxidative stress, but these markers were not significantly improved by hydralazine. CONCLUSION Low-dose hydralazine ameliorated HFD-induced albuminuria and glomerulosclerosis, independent of alterations in biometric and metabolic variables or blood pressure regulation. Although the precise mechanism of renoprotection in obesity is unclear, an epigenetic basis may be implicated. These data support repurposing hydralazine as a novel therapy to prevent CKD progression in obese patients.
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Affiliation(s)
- Benjamin P. Larkin
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Long T. Nguyen
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Miao Hou
- Department of CardiologyChildren′s Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Sarah J. Glastras
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
- Department of DiabetesEndocrinology and Metabolism, Royal North Shore HospitalSydneyAustralia
| | - Hui Chen
- School of Life Sciences, Faculty of ScienceUniversity of Technology SydneySydneyAustralia
| | - Alen Faiz
- School of Life Sciences, Faculty of ScienceUniversity of Technology SydneySydneyAustralia
| | - Jason Chen
- Department of Anatomical PathologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Rosy Wang
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Carol A. Pollock
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
- School of Life Sciences, Faculty of ScienceUniversity of Technology SydneySydneyAustralia
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Chang TT, Chiang CH, Chen C, Lin SC, Lee HJ, Chen JW. Antioxidation and Nrf2-mediated heme oxygenase-1 activation contribute to renal protective effects of hydralazine in diabetic nephropathy. Biomed Pharmacother 2022; 151:113139. [PMID: 35623171 DOI: 10.1016/j.biopha.2022.113139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 12/15/2022] Open
Abstract
Reactive oxygen species (ROS) and oxidative stress are associated with the progression of diabetic nephropathy (DN). Hydralazine is an antihypertensive agent and may act as a xanthine oxidase (XO) inhibitor to reduce uric acid levels in a mouse renal injury model. This study aimed to investigate the potential mechanisms of hydralazine in experimental DN. Streptozotocin-induced diabetic mice were fed a high-fat diet to generate DN. Human renal proximal tubular epithelial cells were used in vitro. Nitrendipine and allopurinol which can reduce blood pressure or XO activity levels, were used as two positive controls. Hydralazine downregulated NF-κB/p38 signaling pathways and reduced TNF-α/IL-6 expressions in high glucose-stimulated renal proximal tubular epithelial cells. Hydralazine reduced in vitro ROS production via XO inhibition and nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated heme oxygenase (HO)-1 activation. Furthermore, hydralazine reduced high glucose-induced apoptosis by downregulating PARP/caspase-3 signaling. Hydralazine and allopurinol but not nitrendipine reduced serum uric acid levels and systemic inflammation. Hydralazine and allopurinol treatment improved renal function with decreased urinary albumin-to-creatinine ratios, glomerular hypertrophy, glomerulosclerosis, and fibrosis in the kidney of DN mice. While both hydralazine and allopurinol downregulated XO and NADPH oxidase expression, only hydralazine upregulated Nrf2/HO-1 renal expression, suggesting the additional effects of hydralazine independent of XO/ NADPH oxidase inhibition. In conclusion, hydralazine protected renal proximal tubular epithelial cells against the insults of high glucose and prevented renal damage via XO/NADPH oxidase inhibition and Nrf-2/HO-1 activation, suggesting the comprehensive antioxidation and anti-inflammation mechanisms for the management of DN.
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Affiliation(s)
- Ting-Ting Chang
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chih-Hung Chiang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan; Department of Urology/Medical Research and Education, Taipei Veterans General Hospital, Yuan-Shan/Su-Ao Branch, Yi-Lan, Taiwan
| | - Ching Chen
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Su-Chu Lin
- Department of Urology/Medical Research and Education, Taipei Veterans General Hospital, Yuan-Shan/Su-Ao Branch, Yi-Lan, Taiwan
| | - Hsin-Jou Lee
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Mavrakanas TA, Soomro QH, Charytan DM. Hydralazine-Isosorbide Dinitrate Use In Patients With End-Stage Kidney Disease On Dialysis. Kidney Int Rep 2022; 7:1332-1340. [PMID: 35685328 PMCID: PMC9171697 DOI: 10.1016/j.ekir.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 10/25/2022] Open
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Mongirdienė A, Skrodenis L, Varoneckaitė L, Mierkytė G, Gerulis J. Reactive Oxygen Species Induced Pathways in Heart Failure Pathogenesis and Potential Therapeutic Strategies. Biomedicines 2022; 10:biomedicines10030602. [PMID: 35327404 PMCID: PMC8945343 DOI: 10.3390/biomedicines10030602] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
With respect to structural and functional cardiac disorders, heart failure (HF) is divided into HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Oxidative stress contributes to the development of both HFrEF and HFpEF. Identification of a broad spectrum of reactive oxygen species (ROS)-induced pathways in preclinical models has provided new insights about the importance of ROS in HFrEF and HFpEF development. While current treatment strategies mostly concern neuroendocrine inhibition, recent data on ROS-induced metabolic pathways in cardiomyocytes may offer additional treatment strategies and targets for both of the HF forms. The purpose of this article is to summarize the results achieved in the fields of: (1) ROS importance in HFrEF and HFpEF pathophysiology, and (2) treatments for inhibiting ROS-induced pathways in HFrEF and HFpEF patients. ROS-producing pathways in cardiomyocytes, ROS-activated pathways in different HF forms, and treatment options to inhibit their action are also discussed.
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Affiliation(s)
- Aušra Mongirdienė
- Department of Biochemistry, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 4, LT-50161 Kaunas, Lithuania
- Correspondence: or ; Tel.: +370-837361768
| | - Laurynas Skrodenis
- Medical Academy, Lithuanian University of Health Sciences, Mickevičiaus str. 9, LT-44307 Kaunas, Lithuania; (L.S.); (L.V.); (G.M.); (J.G.)
| | - Leila Varoneckaitė
- Medical Academy, Lithuanian University of Health Sciences, Mickevičiaus str. 9, LT-44307 Kaunas, Lithuania; (L.S.); (L.V.); (G.M.); (J.G.)
| | - Gerda Mierkytė
- Medical Academy, Lithuanian University of Health Sciences, Mickevičiaus str. 9, LT-44307 Kaunas, Lithuania; (L.S.); (L.V.); (G.M.); (J.G.)
| | - Justinas Gerulis
- Medical Academy, Lithuanian University of Health Sciences, Mickevičiaus str. 9, LT-44307 Kaunas, Lithuania; (L.S.); (L.V.); (G.M.); (J.G.)
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Kalkhoran SB, Kriston-Vizi J, Hernandez-Resendiz S, Crespo-Avilan GE, Rosdah AA, Lees JG, Costa JRSD, Ling NXY, Holien JK, Samangouei P, Chinda K, Yap EP, Riquelme JA, Ketteler R, Yellon DM, Lim SY, Hausenloy DJ. Hydralazine protects the heart against acute ischaemia/reperfusion injury by inhibiting Drp1-mediated mitochondrial fission. Cardiovasc Res 2022; 118:282-294. [PMID: 33386841 PMCID: PMC8752357 DOI: 10.1093/cvr/cvaa343] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS Genetic and pharmacological inhibition of mitochondrial fission induced by acute myocardial ischaemia/reperfusion injury (IRI) has been shown to reduce myocardial infarct size. The clinically used anti-hypertensive and heart failure medication, hydralazine, is known to have anti-oxidant and anti-apoptotic effects. Here, we investigated whether hydralazine confers acute cardioprotection by inhibiting Drp1-mediated mitochondrial fission. METHODS AND RESULTS Pre-treatment with hydralazine was shown to inhibit both mitochondrial fission and mitochondrial membrane depolarisation induced by oxidative stress in HeLa cells. In mouse embryonic fibroblasts (MEFs), pre-treatment with hydralazine attenuated mitochondrial fission and cell death induced by oxidative stress, but this effect was absent in MEFs deficient in the mitochondrial fission protein, Drp1. Molecular docking and surface plasmon resonance studies demonstrated binding of hydralazine to the GTPase domain of the mitochondrial fission protein, Drp1 (KD 8.6±1.0 µM), and inhibition of Drp1 GTPase activity in a dose-dependent manner. In isolated adult murine cardiomyocytes subjected to simulated IRI, hydralazine inhibited mitochondrial fission, preserved mitochondrial fusion events, and reduced cardiomyocyte death (hydralazine 24.7±2.5% vs. control 34.1±1.5%, P=0.0012). In ex vivo perfused murine hearts subjected to acute IRI, pre-treatment with hydralazine reduced myocardial infarct size (as % left ventricle: hydralazine 29.6±6.5% vs. vehicle control 54.1±4.9%, P=0.0083), and in the murine heart subjected to in vivo IRI, the administration of hydralazine at reperfusion, decreased myocardial infarct size (as % area-at-risk: hydralazine 28.9±3.0% vs. vehicle control 58.2±3.8%, P<0.001). CONCLUSION We show that, in addition to its antioxidant and anti-apoptotic effects, hydralazine, confers acute cardioprotection by inhibiting IRI-induced mitochondrial fission, raising the possibility of repurposing hydralazine as a novel cardioprotective therapy for improving post-infarction outcomes.
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Affiliation(s)
- Siavash Beikoghli Kalkhoran
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College, 67 Chenies Mews, WC1E 6HX London, UK
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, 169609, Singapore
| | - Janos Kriston-Vizi
- MRC Laboratory for Molecular Cell Biology, University College, Gower St, Kings Cross, WC1E 6BT London, UK
| | - Sauri Hernandez-Resendiz
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, 169609, Singapore
| | - Gustavo E Crespo-Avilan
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, 169609, Singapore
- Department of Biochemistry, Medical Faculty, Justus Liebig-University, Ludwigstraße 23, 35390 Giessen, Germany
| | - Ayeshah A Rosdah
- O’Brien Institute Department, St Vincent’s Institute of Medical Research, 9 Princes Street Fitzroy Victoria, 3065, Australia
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Bukit Lama, Kec. Ilir Bar. I, Kota Palembang, 30139 Sumatera Selatan, Indonesia
- Department of Surgery and Medicine, University of Melbourne, Medical Building, Cnr Grattan Street & Royal Parade, 3010 Victoria, Australia
| | - Jarmon G Lees
- O’Brien Institute Department, St Vincent’s Institute of Medical Research, 9 Princes Street Fitzroy Victoria, 3065, Australia
- Department of Surgery and Medicine, University of Melbourne, Medical Building, Cnr Grattan Street & Royal Parade, 3010 Victoria, Australia
| | | | - Naomi X Y Ling
- Metabolic Signalling Laboratory, St Vincent’s Institute of Medical Research, School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica K Holien
- Department of Surgery and Medicine, University of Melbourne, Medical Building, Cnr Grattan Street & Royal Parade, 3010 Victoria, Australia
- St Vincent’s Institute of Medical Research, 9 Princes Street, Fitzroy Victoria, 3065, Australia
- ACRF Rational Drug Discovery Centre, St Vincent’s Institute of Medical Research, 9 Princes Street Fitzroy Victoria, 3065, Australia
| | - Parisa Samangouei
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College, 67 Chenies Mews, WC1E 6HX London, UK
- National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, 169609, Singapore
| | - Kroekkiat Chinda
- Department of Physiology, Faculty of Medical Science, Naresuan University, Tha Pho, Mueang Phitsanulok, 65000, Thailand
| | - En Ping Yap
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, 169609, Singapore
| | - Jaime A Riquelme
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College, 67 Chenies Mews, WC1E 6HX London, UK
- Advanced Center for Chronic Disease (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Sergio Livingstone 1007, Independencia, Santiago, Chile
| | - Robin Ketteler
- MRC Laboratory for Molecular Cell Biology, University College, Gower St, Kings Cross, WC1E 6BT London, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College, 67 Chenies Mews, WC1E 6HX London, UK
| | - Shiang Y Lim
- O’Brien Institute Department, St Vincent’s Institute of Medical Research, 9 Princes Street Fitzroy Victoria, 3065, Australia
- Department of Surgery and Medicine, University of Melbourne, Medical Building, Cnr Grattan Street & Royal Parade, 3010 Victoria, Australia
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College, 67 Chenies Mews, WC1E 6HX London, UK
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228, Singapore
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Lioufeng Rd., Wufeng, 41354 Taichung, Taiwan
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Larkin BP, Nguyen LT, Hou M, Glastras SJ, Chen H, Wang R, Pollock CA, Saad S. Novel Role of Gestational Hydralazine in Limiting Maternal and Dietary Obesity-Related Chronic Kidney Disease. Front Cell Dev Biol 2021; 9:705263. [PMID: 34485290 PMCID: PMC8416283 DOI: 10.3389/fcell.2021.705263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/30/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Maternal obesity is a risk factor for chronic kidney disease (CKD) in offspring, underpinning the theory of the developmental origins of health and disease. DNA methylation has been implicated in the programming of adult chronic disease by maternal obesity, therefore, DNA demethylating agents may mitigate offspring risk of disease. In rodent models, low-dose hydralazine has previously been shown to reduce renal fibrosis via DNA demethylation. We used mouse models of maternal obesity and offspring obesity to determine whether administration of low-dose hydralazine during gestation can prevent fetal programming of CKD in offspring. METHODS Female C57BL/6 mice received high fat diet (HFD) or chow prior to mating, during gestation and lactation. During gestation, dams received subcutaneous hydralazine (5 mg/kg) or saline thrice-weekly. Male offspring weaned to HFD or chow, which continued until endpoint at 32 weeks. Biometric and metabolic parameters, renal global DNA methylation, renal functional and structural changes, and renal markers of fibrosis, inflammation and oxidative stress were assessed at endpoint. RESULTS Offspring exposed to maternal obesity or diet-induced obesity had significantly increased renal global DNA methylation, together with other adverse renal effects including albuminuria, glomerulosclerosis, renal fibrosis, and oxidative stress. Offspring exposed to gestational hydralazine had significantly reduced renal global DNA methylation. In obese offspring of obese mothers, gestational hydralazine significantly decreased albuminuria, glomerulosclerosis, and serum creatinine. Obese offspring of hydralazine-treated lean mothers displayed reduced markers of renal fibrosis and oxidative stress. CONCLUSION Gestational hydralazine decreased renal global DNA methylation and exerted renoprotective effects in offspring. This supports a potential therapeutic effect of hydralazine in preventing maternal obesity or dietary obesity-related CKD, through an epigenetic mechanism.
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Affiliation(s)
- Benjamin P. Larkin
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Long T. Nguyen
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Miao Hou
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Sarah J. Glastras
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Hui Chen
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Rosy Wang
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Carol A. Pollock
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sonia Saad
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
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11
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Helmstädter J, Keppeler K, Aust F, Küster L, Frenis K, Filippou K, Vujacic-Mirski K, Tsohataridis S, Kalinovic S, Kröller-Schön S, Oelze M, Bosmann M, Münzel T, Daiber A, Steven S. GLP-1 Analog Liraglutide Improves Vascular Function in Polymicrobial Sepsis by Reduction of Oxidative Stress and Inflammation. Antioxidants (Basel) 2021; 10:antiox10081175. [PMID: 34439423 PMCID: PMC8388926 DOI: 10.3390/antiox10081175] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022] Open
Abstract
Sepsis causes high mortality in the setting of septic shock. LEADER and other trials revealed cardioprotective and anti-inflammatory properties of glucagon-like peptide-1 (GLP-1) analogs like liraglutide (Lira). We previously demonstrated improved survival in lipopolysaccharide (LPS)-induced endotoxemia by inhibition of GLP-1 degradation. Here we investigate the effects of Lira in the polymicrobial sepsis model of cecal ligation and puncture (CLP). C57BL/6J mice were intraperitoneally injected with Lira (200 µg/kg/d; 3 days) and sepsis induced by CLP after one day of GLP-1 analog treatment. Survival and body temperature were monitored. Aortic vascular function (isometric tension recording), protein expression (immunohistochemistry and dot blot) and gene expression (qRT-PCR) were determined. Endothelium-dependent relaxation in the aorta was impaired by CLP and correlated with markers of inflammation (e.g., interleukin 6 and inducible nitric oxide synthase) and oxidative stress (e.g., 3-nitrotyrosine) was higher in septic mice, all of which was almost completely normalized by Lira therapy. We demonstrate that the GLP-1 analog Lira ameliorates sepsis-induced endothelial dysfunction by the reduction of vascular inflammation and oxidative stress. Accordingly, the findings suggest that the antioxidant and anti-inflammatory effects of GLP-1 analogs may be a valuable tool to protect the cardiovascular system from dysbalanced inflammation in polymicrobial sepsis.
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Affiliation(s)
- Johanna Helmstädter
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Karin Keppeler
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Franziska Aust
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Leonie Küster
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Katie Frenis
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Konstantina Filippou
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Ksenija Vujacic-Mirski
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Simeon Tsohataridis
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Sanela Kalinovic
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Swenja Kröller-Schön
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Matthias Oelze
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
| | - Markus Bosmann
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany;
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Thomas Münzel
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Andreas Daiber
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sebastian Steven
- Center for Cardiology, Department of Cardiology 1–Molecular Cardiology, University Medical Center, 55131 Mainz, Germany; (J.H.); (K.K.); (F.A.); (L.K.); (K.F.); (K.F.); (K.V.-M.); (S.T.); (S.K.); (S.K.-S.); (M.O.); (T.M.); (A.D.)
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany;
- Correspondence: ; Tel.: +49-(0)6131-176-948
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12
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Charytan DM, Hsu JY, Mc Causland FR, Waikar SS, Ikizler TA, Raj DS, Landis JR, Mehrotra R, Williams M, DiCarli M, Skali H, Kimmel PL, Kliger AS, Dember LM. Combination Hydralazine and Isosorbide Dinitrate in Dialysis-Dependent ESRD (HIDE): A Randomized, Placebo-Controlled, Pilot Trial. KIDNEY360 2020; 1:1380-1389. [PMID: 35372900 DOI: 10.34067/kid.0004342020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022]
Abstract
Background Combination therapy with isosorbide dinitrate (ISD) and hydralazine (HY) reduces heart failure mortality. The safety and tolerability in individuals requiring maintenance hemodialysis (HD) is unknown. Methods Single-center, randomized, placebo-controlled, double-blind pilot trial to explore safety and tolerability of ISD/HY in maintenance HD. Participants were randomized to placebo or combination ISD/HY. Dose was escalated over 3 weeks from ISD 10 mg/HY 10 mg to ISD 40 mg/HY 75 mg three times per day with the maximum tolerated dose maintained for the subsequent 21 weeks. Primary endpoints included adverse events, adverse events precluding further treatment with study medication, serious hypotension (i.e., requiring hospitalization or emergency room visit), and recurrent intra-dialytic hypotension. Efficacy signals included change in mitral annular E' velocity by tissue Doppler echocardiography and change in left ventricular coronary flow reserve on positron emission tomography. Results A total of 17 individuals were randomized to ISD/HY (N=7) or placebo (N=10). All participants assigned to ISD/HY completed dose escalation to 40/75 mg, but dose reductions were required in two participants. No participants discontinued therapy. There were no serious hypotension events. Recurrent intradialytic hypotension was less frequent with ISD/HY (0.47 events/patient-year) than placebo (1.83 events/patient-year, P=0.04). In contrast, nausea (ISD/HY, 1.90 events/patient-year; placebo, 0.50 events/patient-year, P=0.03) was significantly more frequent, and headache and diarrhea were numerically but not significantly more frequent with ISD/HY. Adverse events were more frequent with ISD/HY (11.4 events/patient-year) than placebo (6.31 events/patient-year). We did not detect between-group differences in the change in E' (P=0.34); ISD/HY showed a mean increase of 0.6 cm/s (SD 1.1), and placebo showed a mean decrease of 0.04 cm/s (SD 0.9). Changes in coronary flow reserve were minimal, -0.3 (0.2) with ISD/HY and -0.03 (0.5) in the placebo group, P=0.19. Conclusions ISD/HY appears to be well tolerated in patients being treated with maintenance HD, but headache and gastrointestinal side effects occur more frequently with ISD/HY compared with placebo.
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Affiliation(s)
- David M Charytan
- Division of Nephrology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology and Informatics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Finnian R Mc Causland
- Renal Division, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Sushrut S Waikar
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, and Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dominic S Raj
- Division of Renal Diseases and Hypertension, George Washington University School of Medicine, Washington, DC
| | - J Richard Landis
- Department of Biostatistics, Epidemiology and Informatics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Mark Williams
- Renal Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marcelo DiCarli
- Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hicham Skali
- Cardiovascular Division, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alan S Kliger
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Lim SL, Gandhi M, Woo KL, Chua HR, Lim YC, Sim DKL, Lee SSG, Teoh YL, Richards AM, Lam CSP. Nitrates in combination with hydralazine in cardiorenal syndrome: a randomized controlled proof-of-concept study. ESC Heart Fail 2020; 7:4267-4276. [PMID: 33150715 PMCID: PMC7754984 DOI: 10.1002/ehf2.13076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiorenal syndrome (CRS) is a common problem of great morbidity and mortality. Hydralazine-isosorbide dinitrate (H-ISDN) may be used in renal failure and may improve exercise capacity in heart failure (HF). Our proof-of-concept study aimed to evaluate early evidence of efficacy, safety, and feasibility of H-ISDN compared with standard of care in CRS. METHODS AND RESULTS This multi-centre, single-blind, randomized trial in Singapore enrolled CRS patients, defined as chronic HF with concomitant renal failure [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 ]. The primary outcome was 6 min walk test (6MWT) distance measured at 6 months. Secondary outcomes included study feasibility; efficacy outcomes which included renal, cardiac, and endothelial functions, health-related quality of life using Short Form-36, clinical outcomes; and adverse events. Forty-four patients [71 ± 10 years; 75% male; median (inter-quartile range) N-terminal prohormone brain natriuretic peptide 1346 (481-2272) pg/mL] with CRS (left ventricular ejection fraction 42 ± 12% and eGFR 46 ± 15 ml/min/1.73 m2 ) were randomized into two equal groups. Of these, 39 (89%) had hypertension, 27 (61%) had diabetes mellitus, and 17 (39%) had atrial fibrillation. Six (27%) discontinued H-ISDN owing to intolerance and poor compliance. There was a trend towards improved 6MWT distance with H-ISDN compared with standard of care at 6 months (mean difference 27 m; 95% CI, -12 to 66), with little differences in secondary efficacy outcomes. Giddiness and hypotension occurred more frequently with H-ISDN, but HF hospitalizations and mortality were less. CONCLUSIONS Our pilot study does not support the addition of H-ISDN on top of standard medical therapy to improve exercise capacity in patients with CRS.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, 1E Kent Ridge Road, 119228, Singapore
| | - Mihir Gandhi
- Singapore Clinical Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Global Health Group, Center for Child Health Research, Tampere University, Tampere, Finland
| | - Kai Lee Woo
- Department of Cardiology, National University Heart Center, 1E Kent Ridge Road, 119228, Singapore
| | - Horng Ruey Chua
- Division of Nephrology, National University Hospital, Singapore
| | - Yoke Ching Lim
- Department of Cardiology, National University Heart Center, 1E Kent Ridge Road, 119228, Singapore
| | - David K L Sim
- Department of Cardiology, National Heart Center, Singapore
| | - Sheldon S G Lee
- Department of Cardiology, Changi General Hospital, Singapore
| | - Yee Leong Teoh
- Singapore Clinical Research Institute, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Arthur Mark Richards
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore.,Cardiovascular Research Institute, National University Heart Center, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Carolyn S P Lam
- Duke-NUS Medical School, Singapore.,Department of Cardiology, National Heart Center, Singapore
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14
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Long W, Liao H, Liu Q, Ning Y, Wu T, Kang J, Liu J, Xian S, Yang Z. Effect of nitrate treatment on functional capacity and exercise time in patients with heart failure: a systematic review and meta-analysis. J Int Med Res 2020; 48:300060520939742. [PMID: 32762413 PMCID: PMC7557692 DOI: 10.1177/0300060520939742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objectives Heart failure (HF) is a common and potentially fatal condition. In 2015, HF affected approximately 40 million people globally. Evidence showing that the use of nitrates can improve clinical outcomes in patients with HF is limited. This study aimed to assess the effect of nitrates on functional capacity and exercise time in patients with HF. Methods PubMed, Cochrane Library, and Embase databases were reviewed for articles on the use of nitrates and other treatments for patients with HF. The primary endpoints were the 6-minute walk test distance, exercise time, and quality of life. Secondary endpoints were all-cause mortality, arrhythmia, hospitalization, and worsening HF. The weighted mean difference, risk ratio, and 95% confidence interval were calculated. Results A total of 14 related studies that comprised 26,321 patients were included. No significant differences were found in the 6-minute walk test distance, exercise time, and quality of life between the nitrate and control treatment groups. There were also no differences in all-cause mortality, the incidence of arrhythmia, hospitalization, and worsening HF between these two groups. Conclusion Patients with HF who receive nitrate treatment do not have better quality of life or exercise capacity compared with controls.
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Affiliation(s)
- Wenjie Long
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Gaungzhou, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huili Liao
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Gaungzhou, China
| | - Qingqing Liu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yile Ning
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tingchun Wu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Cardiology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Jinhua Kang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianhong Liu
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Gaungzhou, China
| | - Shaoxiang Xian
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Gaungzhou, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhongqi Yang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Gaungzhou, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
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15
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Santisteban MM, Ahn SJ, Lane D, Faraco G, Garcia-Bonilla L, Racchumi G, Poon C, Schaeffer S, Segarra SG, Körbelin J, Anrather J, Iadecola C. Endothelium-Macrophage Crosstalk Mediates Blood-Brain Barrier Dysfunction in Hypertension. Hypertension 2020; 76:795-807. [PMID: 32654560 DOI: 10.1161/hypertensionaha.120.15581] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is a leading cause of stroke and dementia, effects attributed to disrupting delivery of blood flow to the brain. Hypertension also alters the blood-brain barrier (BBB), a critical component of brain health. Although endothelial cells are ultimately responsible for the BBB, the development and maintenance of the barrier properties depend on the interaction with other vascular-associated cells. However, it remains unclear if BBB disruption in hypertension requires cooperative interaction with other cells. Perivascular macrophages (PVM), innate immune cells closely associated with cerebral microvessels, have emerged as major contributors to neurovascular dysfunction. Using 2-photon microscopy in vivo and electron microscopy in a mouse model of Ang II (angiotensin II) hypertension, we found that the vascular segments most susceptible to increased BBB permeability are arterioles and venules >10 µm and not capillaries. Brain macrophage depletion with clodronate attenuates, but does not abolish, the increased BBB permeability in these arterioles where PVM are located. Deletion of AT1R (Ang II type-1 receptors) in PVM using bone marrow chimeras partially attenuated the BBB dysfunction through the free radical-producing enzyme Nox2. In contrast, downregulation of AT1R in cerebral endothelial cells using a viral gene transfer-based approach prevented the BBB disruption completely. The results indicate that while endothelial AT1R, mainly in arterioles and venules, initiate the BBB disruption in hypertension, PVM are required for the full expression of the dysfunction. The findings unveil a previously unappreciated contribution of resident brain macrophages to increased BBB permeability of hypertension and identify PVM as a putative therapeutic target in diseases associated with BBB dysfunction.
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Affiliation(s)
- Monica M Santisteban
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Sung Ji Ahn
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Diane Lane
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Giuseppe Faraco
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Lidia Garcia-Bonilla
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Gianfranco Racchumi
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Carrie Poon
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Samantha Schaeffer
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Steven G Segarra
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Jakob Körbelin
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.K.)
| | - Josef Anrather
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
| | - Costantino Iadecola
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (M.M.S., S.J.A., D.L., G.F., L.G.-B., G.R., C.P., S.S., S.G.S., J.A., C.I.)
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16
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Hydralazine improves ischemia-induced neovasculogenesis via xanthine-oxidase inhibition in chronic renal insufficiency. Pharmacol Res 2019; 151:104509. [PMID: 31678640 DOI: 10.1016/j.phrs.2019.104509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/13/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023]
Abstract
Oxidative stress is related to the progression of renal diseases and modulation of oxidative stress can lead to a reduction in vascular events in patients with chronic renal insufficiency (CRI). Indoxyl sulfate (IS) and xanthine oxidase (XO) are related to impaired neovasculogenesis in CRI. Hydralazine is suggested for blood pressure control in CRI. This study aimed to investigate whether hydralazine could improve ischemia-induced neovasculogenesis in CRI animals by reducing reactive oxygen species (ROS) levels. Mice underwent subtotal nephrectomy or sham surgery. Nitrendipine, probenecid, and allopurinol were used to reduce blood pressure, uric acid (UA), and XO activity levels, respectively, for comparison. Blood pressure, XO activity and UA levels that were increased after subtotal nephrectomy were reduced by hydralazine treatment. Allopurinol decreased blood XO activity and UA levels. Only hydralazine and allopurinol increased the number of circulating endothelial progenitor cells (EPCs) and improved neovasculogenesis in CRI mice. IS activated XO mRNA and ROS and inhibited the functions of EPCs and endothelial cells, which could be reversed by hydralazine. However, no additional beneficial effects were observed when XO was inhibited with both hydralazine and siRNA. In conclusion, hydralazine, as a potential XO inhibitor, not only reduced blood pressure and UA levels but also increased the number of circulating EPCs and improved neovasculogenesis in CRI animals. Hydralazine directly inhibited IS-induced ROS and XO activation in EPCs and endothelial cells, and restored their functions in vitro. Future studies should evaluate whether hydralazine could provide additional vascular protection in patients with CRI.
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Abstract
Nitrite, an anion produced from the oxidative breakdown of nitric oxide (NO), has traditionally been viewed as an inert molecule. However, this dogma has been challenged with the findings that nitrite can be readily reduced to NO under pathological conditions, hence representing a physiologically relevant storage reservoir of NO either in the blood or tissues. Nitrite administration has been demonstrated to improve myocardial function in subjects with heart failure and to lower the blood pressure in hypertensive subjects. Thus, extensive amount of work has since been carried out to investigate the therapeutic potential of nitrite in treating cardiovascular diseases, especially hypertension. Studies done on several animal models of hypertension have demonstrated the efficacy of nitrite in preventing and ameliorating the pathological changes associated with the disease. This brief review of the current findings aims to re-evaluate the use of nitrite for the treatment of hypertension and in particular to highlight its role in improving endothelial function.
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Affiliation(s)
- Wei Chih Ling
- Department of Pre-clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor; and
| | - Mohd Rais Mustafa
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Dharmani Devi Murugan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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The Endothelin Receptor Antagonist Macitentan Improves Isosorbide-5-Mononitrate (ISMN) and Isosorbide Dinitrate (ISDN) Induced Endothelial Dysfunction, Oxidative Stress, and Vascular Inflammation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2018:7845629. [PMID: 30687454 PMCID: PMC6327264 DOI: 10.1155/2018/7845629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022]
Abstract
Objective Organic nitrates such as isosorbide-5-mononitrate (ISMN) and isosorbide dinitrate (ISDN) are used for the treatment of patients with chronic symptomatic stable coronary artery disease and chronic congestive heart failure. Limiting side effects of these nitrovasodilators include nitrate tolerance and/or endothelial dysfunction mediated by oxidative stress. Here, we tested the therapeutic effects of the dual endothelin (ET) receptor antagonist macitentan in ISMN- and ISDN-treated animals. Methods and Results Organic nitrates (ISMN, ISDN, and nitroglycerin (GTN)) augmented the oxidative burst and interleukin-6 release in cultured macrophages, whereas macitentan decreased the oxidative burst in isolated human leukocytes. Male C57BL/6j mice were treated with ISMN (75 mg/kg/d) or ISDN (25 mg/kg/d) via s.c. infusion for 7 days and some mice in addition with 30 mg/kg/d of macitentan (gavage, once daily). ISMN and ISDN in vivo therapy caused endothelial dysfunction but no nitrate (or cross-)tolerance to the organic nitrates, respectively. ISMN/ISDN increased blood nitrosative stress, vascular/cardiac oxidative stress via NOX-2 (fluorescence and chemiluminescence methods), ET1 expression, ET receptor signaling, and markers of inflammation (protein and mRNA level). ET receptor signaling blockade by macitentan normalized endothelial function, vascular/cardiac oxidative stress, and inflammatory phenotype in both nitrate therapy groups. Conclusion ISMN/ISDN treatment caused activation of the NOX-2/ET receptor signaling axis leading to increased vascular oxidative stress and inflammation as well as endothelial dysfunction. Our study demonstrates for the first time that blockade of ET receptor signaling by the dual endothelin receptor blocker macitentan improves adverse side effects of the organic nitrates ISMN and ISDN.
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Münzel T, Daiber A. Inorganic nitrite and nitrate in cardiovascular therapy: A better alternative to organic nitrates as nitric oxide donors? Vascul Pharmacol 2018; 102:1-10. [DOI: 10.1016/j.vph.2017.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/11/2017] [Accepted: 11/12/2017] [Indexed: 01/08/2023]
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20
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Iulita MF, Vallerand D, Beauvillier M, Haupert N, A Ulysse C, Gagné A, Vernoux N, Duchemin S, Boily M, Tremblay MÈ, Girouard H. Differential effect of angiotensin II and blood pressure on hippocampal inflammation in mice. J Neuroinflammation 2018; 15:62. [PMID: 29490666 PMCID: PMC6389185 DOI: 10.1186/s12974-018-1090-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022] Open
Abstract
Background Angiotensin II (Ang II), a peptide hormone involved in the development of hypertension, causes systemic and cerebral inflammation, affecting brain regions important for blood pressure control. The cause-and-effect relationship between hypertension and inflammation is two-way, but the role of blood pressure in the induction of cerebral inflammation is less clear. The vulnerability of specific brain regions, particularly those important for memory, is also of interest. Methods We used molecular biology approaches, immunohistochemistry, and electron microscopy to examine the interdependence between the hypertensive and pro-inflammatory effects of Ang II. We examined the effect of blood pressure by administering a subpressive (200 ng/kg/min) or a pressive Ang II dose (1000 or 1900 ng/kg/min) with and without hydralazine (150 mg/L) for 1 week and used phenylephrine to increase blood pressure independently of the renin-angiotensin system. Results Ang II increased ionized calcium-binding adaptor molecule 1 (Iba-1) levels (marker of microgliosis) in the whole brain and in the hippocampus in a dose-dependent manner. Pressive Ang II induced specific changes in microglial morphology, indicating differences in functional phenotype. An increase in hippocampal glial fibrillary acidic protein (GFAP) was seen in mice receiving pressive Ang II, while no induction of cerebral gliosis was observed after 7 days of subpressive Ang II infusion. Although phenylephrine led to increased astrogliosis, it did not affect Iba-1 expression. Pressive Ang II stimulated TNF-α production in the hippocampus, and daily treatment with hydralazine prevented this increase. Hydralazine also reduced GFAP and Iba-1 levels. With longer perfusion (14 days), subpressive Ang II led to some but not all the inflammatory changes detected with the pressive doses, mainly an increase in CD68 and Iba-1 but not of GFAP or TNF-α. Conclusions Blood pressure and Ang II differentially contribute to hippocampal inflammation in mice. Control of blood pressure and Ang II levels should prevent or reduce brain inflammation and therefore brain dysfunctions associated with hypertension. Electronic supplementary material The online version of this article (10.1186/s12974-018-1090-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Florencia Iulita
- Department of Neurosciences, Université de Montréal, 2960 Chemin de la Tour, Montréal, Québec, H3T 1J4, Canada.,Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, 2960 Chemin de la Tour, Montréal, Québec, H3T 1J4, Canada
| | - Diane Vallerand
- Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Mélissa Beauvillier
- Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Nathalie Haupert
- Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Corinne A Ulysse
- Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Audrey Gagné
- Axe Neurosciences, CRCHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
| | - Nathalie Vernoux
- Axe Neurosciences, CRCHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
| | - Sonia Duchemin
- Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Michaël Boily
- Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Marie-Ève Tremblay
- Axe Neurosciences, CRCHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, Québec, G1V 4G2, Canada.,Department of Molecular Medicine, Université Laval, 1050, Avenue de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Hélène Girouard
- Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, 2960 Chemin de la Tour, Montréal, Québec, H3T 1J4, Canada. .,Department of Pharmacology and Physiology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada. .,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 545 Queen Mary Rd, Montréal, Québec, H3W 1W6, Canada.
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Singh P, Vijayakumar S, Kalogeroupoulos A, Butler J. Multiple Avenues of Modulating the Nitric Oxide Pathway in Heart Failure Clinical Trials. Curr Heart Fail Rep 2018; 15:44-52. [DOI: 10.1007/s11897-018-0383-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Nègre-Salvayre A, Garoby-Salom S, Swiader A, Rouahi M, Pucelle M, Salvayre R. Proatherogenic effects of 4-hydroxynonenal. Free Radic Biol Med 2017; 111:127-139. [PMID: 28040472 DOI: 10.1016/j.freeradbiomed.2016.12.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/22/2016] [Accepted: 12/24/2016] [Indexed: 01/08/2023]
Abstract
4-hydroxy-2-nonenal (HNE) is a α,β-unsaturated hydroxyalkenal generated by peroxidation of n-6 polyunsaturated fatty acid. This reactive carbonyl compound exhibits a huge number of biological properties that result mainly from the formation of HNE-adducts on free amino groups and thiol groups in proteins. In the vascular system, HNE adduct accumulation progressively leads to cellular dysfunction and tissue damages that are involved in the progression of atherosclerosis and related diseases. HNE contributes to the atherogenicity of oxidized LDL, by forming HNE-apoB adducts that deviate the LDL metabolism to the scavenger receptor pathway of macrophagic cells, and lead to the formation of foam cells. HNE activates transcription factors (Nrf2, NF-kappaB) that (dys)regulate various cellular responses ranging from hormetic and survival signaling at very low concentrations, to inflammatory and apoptotic effects at higher concentrations. Among a variety of cellular targets, HNE can modify signaling proteins involved in atherosclerotic plaque remodeling, particularly growth factor receptors (PDGFR, EGFR), cell cycle proteins, mitochondrial and endoplasmic reticulum components or extracellular matrix proteins, which progressively alters smooth muscle cell proliferation, angiogenesis and induces apoptosis. HNE adducts accumulate in the lipidic necrotic core of advanced atherosclerotic lesions, and may locally contribute to macrophage and smooth muscle cell apoptosis, which may induce plaque destabilization and rupture, thereby increasing the risk of athero-thrombotic events.
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Affiliation(s)
| | | | | | | | | | - Robert Salvayre
- Inserm UMR-1048, France; University of Toulouse, Faculty of Medicine, Biochemistry Dept, Toulouse, France; CHU Toulouse, Rangueil, Toulouse, France
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Münzel T, Camici GG, Maack C, Bonetti NR, Fuster V, Kovacic JC. Impact of Oxidative Stress on the Heart and Vasculature: Part 2 of a 3-Part Series. J Am Coll Cardiol 2017; 70:212-229. [PMID: 28683969 DOI: 10.1016/j.jacc.2017.05.035] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 02/07/2023]
Abstract
Vascular disease and heart failure impart an enormous burden in terms of global morbidity and mortality. Although there are many different causes of cardiac and vascular disease, most causes share an important pathological mechanism: oxidative stress. In the failing heart, oxidative stress occurs in the myocardium and correlates with left ventricular dysfunction. Reactive oxygen species (ROS) negatively affect myocardial calcium handling, cause arrhythmia, and contribute to cardiac remodeling by inducing hypertrophic signaling, apoptosis, and necrosis. Similarly, oxidative balance in the vasculature is tightly regulated by a wealth of pro- and antioxidant systems that orchestrate region-specific ROS production and removal. Reactive oxygen species also regulate multiple vascular cell functions, including endothelial and smooth muscle cell growth, proliferation, and migration; angiogenesis; apoptosis; vascular tone; host defenses; and genomic stability. However, excessive levels of ROS promote vascular disease through direct and irreversible oxidative damage to macromolecules, as well as disruption of redox-dependent vascular wall signaling processes.
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Affiliation(s)
- Thomas Münzel
- Center for Cardiology Mainz, Cardiology I, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
| | - Christoph Maack
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Nicole R Bonetti
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Daiber A, Oelze M, Steven S, Kröller-Schön S, Münzel T. Taking up the cudgels for the traditional reactive oxygen and nitrogen species detection assays and their use in the cardiovascular system. Redox Biol 2017; 12:35-49. [PMID: 28212522 PMCID: PMC5312509 DOI: 10.1016/j.redox.2017.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 02/08/2023] Open
Abstract
Reactive oxygen and nitrogen species (RONS such as H2O2, nitric oxide) confer redox regulation of essential cellular functions (e.g. differentiation, proliferation, migration, apoptosis), initiate and catalyze adaptive stress responses. In contrast, excessive formation of RONS caused by impaired break-down by cellular antioxidant systems and/or insufficient repair of the resulting oxidative damage of biomolecules may lead to appreciable impairment of cellular function and in the worst case to cell death, organ dysfunction and severe disease phenotypes of the entire organism. Therefore, the knowledge of the severity of oxidative stress and tissue specific localization is of great biological and clinical importance. However, at this level of investigation quantitative information may be enough. For the development of specific drugs, the cellular and subcellular localization of the sources of RONS or even the nature of the reactive species may be of great importance, and accordingly, more qualitative information is required. These two different philosophies currently compete with each other and their different needs (also reflected by different detection assays) often lead to controversial discussions within the redox research community. With the present review we want to shed some light on these different philosophies and needs (based on our personal views), but also to defend some of the traditional assays for the detection of RONS that work very well in our hands and to provide some guidelines how to use and interpret the results of these assays. We will also provide an overview on the "new assays" with a brief discussion on their strengths but also weaknesses and limitations.
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Affiliation(s)
- Andreas Daiber
- Laboratory of Molecular Cardiology, Center of Cardiology, Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Matthias Oelze
- Laboratory of Molecular Cardiology, Center of Cardiology, Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Steven
- Laboratory of Molecular Cardiology, Center of Cardiology, Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Swenja Kröller-Schön
- Laboratory of Molecular Cardiology, Center of Cardiology, Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Münzel
- Laboratory of Molecular Cardiology, Center of Cardiology, Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Abusarah J, Bentz M, Benabdoune H, Rondon PE, Shi Q, Fernandes JC, Fahmi H, Benderdour M. An overview of the role of lipid peroxidation-derived 4-hydroxynonenal in osteoarthritis. Inflamm Res 2017; 66:637-651. [PMID: 28447122 DOI: 10.1007/s00011-017-1044-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Over the years, many theories have been proposed and examined to better explain the etiology and development of osteoarthritis (OA). The characteristics of joint destruction are one of the most important aspects in disease progression. Therefore, investigating different factors and signaling pathways involved in the alteration of extracellular matrix (ECM) turnover, and the subsequent catabolic damage to cartilage holds chief importance in understanding OA development. Among these factors, reactive oxygen species (ROS) have been at the forefront of the physiological and pathophysiological OA investigation. FINDINGS In the last decades, research studies provided an enormous volume of data supporting the involvement of ROS in OA. Most interestingly, published data regarding the effect of exogenous antioxidant therapy in OA lack conclusive results from clinical trials to back up in vitro data. Accordingly, it is rational to suggest that there are other reactive species in OA that are not taken into account. Thus, our present review is focused on our current understanding of the involvement of lipid peroxidation-derived 4-hydroxynonenal (HNE) in OA. CONCLUSION Our findings, like those in the literature, illustrate the central role played by HNE in the regulation of a number of factors involved in joint homeostasis. HNE could thus be considered as an attractive therapeutic target in OA.
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Affiliation(s)
- Jamilah Abusarah
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Mireille Bentz
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Houda Benabdoune
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Patricia Elsa Rondon
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Qin Shi
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Julio C Fernandes
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Hassan Fahmi
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Mohamed Benderdour
- Orthopaedic Research Laboratory, Hôpital du Sacré-Coeur de Montréal and Department of Surgery, University of Montreal, Room K-3045, 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.
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Zamani P, Akers S, Soto-Calderon H, Beraun M, Koppula MR, Varakantam S, Rawat D, Shiva-Kumar P, Haines PG, Chittams J, Townsend RR, Witschey WR, Segers P, Chirinos JA. Isosorbide Dinitrate, With or Without Hydralazine, Does Not Reduce Wave Reflections, Left Ventricular Hypertrophy, or Myocardial Fibrosis in Patients With Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.116.004262. [PMID: 28219917 PMCID: PMC5523746 DOI: 10.1161/jaha.116.004262] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Wave reflections, which are increased in patients with heart failure with preserved ejection fraction, impair diastolic function and promote pathologic myocardial remodeling. Organic nitrates reduce wave reflections acutely, but whether this is sustained chronically or affected by hydralazine coadministration is unknown. Methods and Results We randomized 44 patients with heart failure with preserved ejection fraction in a double‐blinded fashion to isosorbide dinitrate (ISDN; n=13), ISDN+hydralazine (ISDN+hydral; n=15), or placebo (n=16) for 6 months. The primary end point was the change in reflection magnitude (RM; assessed with arterial tonometry and Doppler echocardiography). Secondary end points included change in left ventricular mass and fibrosis, measured with cardiac magnetic resonance imaging, and the 6‐minute walk distance. ISDN reduced aortic characteristic impedance (mean baseline=0.15 [95% CI, 0.14–0.17], 3 months=0.11 [95% CI, 0.10–0.13], 6 months=0.10 [95% CI, 0.08–0.12] mm Hg/mL per second; P=0.003) and forward wave amplitude (Pf, mean baseline=54.8 [95% CI, 47.6–62.0], 3 months=42.2 [95% CI, 33.2–51.3]; 6 months=37.0 [95% CI, 27.2–46.8] mm Hg, P=0.04), but had no effect on RM (P=0.64), left ventricular mass (P=0.33), or fibrosis (P=0.63). ISDN+hydral increased RM (mean baseline=0.39 [95% CI, 0.35–0.43]; 3 months=0.31 [95% CI, 0.25–0.36]; 6 months=0.44 [95% CI, 0.37–0.51], P=0.03), reduced 6‐minute walk distance (mean baseline=343.3 [95% CI, 319.2–367.4]; 6 months=277.0 [95% CI, 242.7–311.4] meters, P=0.022), and increased native myocardial T1 (mean baseline=1016.2 [95% CI, 1002.7–1029.7]; 6 months=1054.5 [95% CI, 1036.5–1072.3], P=0.021). A high proportion of patients experienced adverse events with active therapy (ISDN=61.5%, ISDN+hydral=60.0%; placebo=12.5%; P=0.007). Conclusions ISDN, with or without hydralazine, does not exert beneficial effects on RM, left ventricular remodeling, or submaximal exercise and is poorly tolerated. ISDN+hydral appears to have deleterious effects on RM, myocardial remodeling, and submaximal exercise. Our findings do not support the routine use of these vasodilators in patients with heart failure with preserved ejection fraction. Clinical Trial Registration URL: www.clinicaltrials.gov. Unique identifier: NCT01516346.
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Affiliation(s)
- Payman Zamani
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Scott Akers
- Department of Radiology, Philadelphia Veterans' Affairs Medical Center, Philadelphia, PA
| | - Haideliza Soto-Calderon
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Melissa Beraun
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Maheswara R Koppula
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Swapna Varakantam
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Deepa Rawat
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Prithvi Shiva-Kumar
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Philip G Haines
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.,Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jesse Chittams
- Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Raymond R Townsend
- Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Walter R Witschey
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patrick Segers
- Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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27
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Nyolczas N, Dékány M, Muk B, Szabó B. Combination of Hydralazine and Isosorbide-Dinitrate in the Treatment of Patients with Heart Failure with Reduced Ejection Fraction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1067:31-45. [PMID: 29086392 DOI: 10.1007/5584_2017_112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The use of direct acting vasodilators (the combination of hydralazine and isosorbide dinitrate -Hy+ISDN-) in heart failure with reduced ejection fraction (HFrEF) is supported by evidence, but rarely used.However, treatment with Hy+ISDN is guideline-recommended for HFrEF patients who cannot receive either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers due to intolerance or contraindication, and in self-identified African-American HFrEF patients who are symptomatic despite optimal neurohumoral therapy.The Hy+ISDN combination has arterial and venous vasodilating properties. It can decrease preload and afterload, decrease left ventricular end-diastolic diameter and the volume of mitral regurgitation, reduce left atrial and left ventricular wall tension, decrease pulmonary artery pressure and pulmonary arterial wedge pressure, increase stroke volume, and improve left ventricular ejection fraction, as well as induce left ventricular reverse remodelling. Furthermore, Hy+ISDN combination has antioxidant property, it affects endothelial dysfunction beneficially and improves NO bioavailability. Because of these benefits, this combination can improve the signs and symptoms of heart failure, exercise capacity and quality of life, and, most importantly, reduce morbidity and mortality in well-defined subgroups of HFrEF patients.Accordingly, this therapeutic option can in many cases play an essential role in the treatment of HFrEF.
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Affiliation(s)
- Noémi Nyolczas
- Department for Cardiology, Hungarian Defence Forces - Medical Centre, Budapest, Hungary.
| | - Miklós Dékány
- Department for Cardiology, Hungarian Defence Forces - Medical Centre, Budapest, Hungary
| | - Balázs Muk
- Department for Cardiology, Hungarian Defence Forces - Medical Centre, Budapest, Hungary
| | - Barna Szabó
- Heart-Lung Clinic, University Hospital Örebro, Örebro, Sweden
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Itani HA, McMaster WG, Saleh MA, Nazarewicz RR, Mikolajczyk TP, Kaszuba AM, Konior A, Prejbisz A, Januszewicz A, Norlander AE, Chen W, Bonami RH, Marshall AF, Poffenberger G, Weyand CM, Madhur MS, Moore DJ, Harrison DG, Guzik TJ. Activation of Human T Cells in Hypertension: Studies of Humanized Mice and Hypertensive Humans. Hypertension 2016; 68:123-32. [PMID: 27217403 DOI: 10.1161/hypertensionaha.116.07237] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/29/2016] [Indexed: 01/11/2023]
Abstract
Emerging evidence supports an important role for T cells in the genesis of hypertension. Because this work has predominantly been performed in experimental animals, we sought to determine whether human T cells are activated in hypertension. We used a humanized mouse model in which the murine immune system is replaced by the human immune system. Angiotensin II increased systolic pressure to 162 versus 116 mm Hg for sham-treated animals. Flow cytometry of thoracic lymph nodes, thoracic aorta, and kidney revealed increased infiltration of human leukocytes (CD45(+)) and T lymphocytes (CD3(+) and CD4(+)) in response to angiotensin II infusion. Interestingly, there was also an increase in the memory T cells (CD3(+)/CD45RO(+)) in the aortas and lymph nodes. Prevention of hypertension using hydralazine and hydrochlorothiazide prevented the accumulation of T cells in these tissues. Studies of isolated human T cells and monocytes indicated that angiotensin II had no direct effect on cytokine production by T cells or the ability of dendritic cells to drive T-cell proliferation. We also observed an increase in circulating interleukin-17A producing CD4(+) T cells and both CD4(+) and CD8(+) T cells that produce interferon-γ in hypertensive compared with normotensive humans. Thus, human T cells become activated and invade critical end-organ tissues in response to hypertension in a humanized mouse model. This response likely reflects the hypertensive milieu encountered in vivo and is not a direct effect of the hormone angiotensin II.
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Affiliation(s)
- Hana A Itani
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - William G McMaster
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Mohamed A Saleh
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Rafal R Nazarewicz
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Tomasz P Mikolajczyk
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Anna M Kaszuba
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Anna Konior
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Aleksander Prejbisz
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Andrzej Januszewicz
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Allison E Norlander
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Wei Chen
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Rachel H Bonami
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Andrew F Marshall
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Greg Poffenberger
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Cornelia M Weyand
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Meena S Madhur
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - Daniel J Moore
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
| | - David G Harrison
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.).
| | - Tomasz J Guzik
- From the Division of Clinical Pharmacology, Department of Medicine (H.A.I., W.G.M., M.A.S., A.E.N., W.C., M.S.M., D.G.H.), General Surgery (W.G.M.), Division of Rheumatology, Department of Medicine (R.H.B.), Division of Endocrinology and Diabetes, Department of Pediatrics (A.F.M., D.J.M.), Division of Endocrinology, Department of Medicine (G.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt (M.A.S.); Divison of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, CA (R.R.N., C.M.W.); Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland (T.P.M., A.M.K., A.K., T.J.G.); Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.M.K., A.P., A.J.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.J.G.)
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Loudon BL, Noordali H, Gollop ND, Frenneaux MP, Madhani M. Present and future pharmacotherapeutic agents in heart failure: an evolving paradigm. Br J Pharmacol 2016; 173:1911-24. [PMID: 26993743 PMCID: PMC4882493 DOI: 10.1111/bph.13480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/28/2016] [Accepted: 02/26/2016] [Indexed: 02/06/2023] Open
Abstract
Many conditions culminate in heart failure (HF), a multi‐organ systemic syndrome with an intrinsically poor prognosis. Pharmacotherapeutic agents that correct neurohormonal dysregulation and haemodynamic instability have occupied the forefront of developments within the treatment of HF in the past. Indeed, multiple trials aimed to validate these agents in the 1980s and early 1990s, resulting in a large and robust evidence‐base supporting their use clinically. An established treatment paradigm now exists for the treatment of HF with reduced ejection fraction (HFrEF), but there have been very few notable developments in recent years. HF remains a significant health concern with an increasing incidence as the population ages. We may indeed be entering the surgical era for HF treatment, but these therapies remain expensive and inaccessible to many. Newer pharmacotherapeutic agents are slowly emerging, many targeting alternative therapeutic pathways, but with mixed results. Metabolic modulation and manipulation of the nitrate/nitrite/nitric oxide pathway have shown promise and could provide the answers to fill the therapeutic gap between medical interventions and surgery, but further definitive trials are warranted. We review the significant evidence base behind the current medical treatments for HFrEF, the physiology of metabolic impairment in HF, and discuss two promising novel agents, perhexiline and nitrite.
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Affiliation(s)
- Brodie L Loudon
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Hannah Noordali
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nicholas D Gollop
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Michael P Frenneaux
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Melanie Madhani
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Abstract
Although the period from 1953 to 2001 resulted in the approval of more than 30 medications currently used to treat heart failure (HF), few novel drugs have been approved in the last decade. However, the investigational pipeline for HF medications once again appears promising. In patients with chronic heart failure with reduced ejection fraction (HFrEF), ivabradine and valsartan/sucubitril (LCZ696) were recently approved by the US Food and Drug Administration. Both agents have been shown to reduce the risk of cardiovascular death and HF hospitalization. In the treatment of acute HF, serelaxin and ularitide are the farthest along in development. Both agents have demonstrated favorable effects on surrogate end points and preliminary data suggest a possible mortality benefit with serelaxin. Consequently, phase 3 trials are ongoing to evaluate the effect of serelaxin and ularitide on clinical outcomes. Given the poor history of recent investigational acute HF drugs that have advanced to phase 3/4 studies, enthusiasm for both serelaxin and ularitide must be tempered until these trials are completed.
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Affiliation(s)
- Sarah Hanigan
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI, USA
| | - Robert J. DiDomenico
- Department of Pharmacy Practice, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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Daiber A, Münzel T. Organic Nitrate Therapy, Nitrate Tolerance, and Nitrate-Induced Endothelial Dysfunction: Emphasis on Redox Biology and Oxidative Stress. Antioxid Redox Signal 2015; 23:899-942. [PMID: 26261901 PMCID: PMC4752190 DOI: 10.1089/ars.2015.6376] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Organic nitrates, such as nitroglycerin (GTN), isosorbide-5-mononitrate and isosorbide dinitrate, and pentaerithrityl tetranitrate (PETN), when given acutely, have potent vasodilator effects improving symptoms in patients with acute and chronic congestive heart failure, stable coronary artery disease, acute coronary syndromes, or arterial hypertension. The mechanisms underlying vasodilation include the release of •NO or a related compound in response to intracellular bioactivation (for GTN, the mitochondrial aldehyde dehydrogenase [ALDH-2]) and activation of the enzyme, soluble guanylyl cyclase. Increasing cyclic guanosine-3',-5'-monophosphate (cGMP) levels lead to an activation of the cGMP-dependent kinase I, thereby causing the relaxation of the vascular smooth muscle by decreasing intracellular calcium concentrations. The hemodynamic and anti-ischemic effects of organic nitrates are rapidly lost upon long-term (low-dose) administration due to the rapid development of tolerance and endothelial dysfunction, which is in most cases linked to increased intracellular oxidative stress. Enzymatic sources of reactive oxygen species under nitrate therapy include mitochondria, NADPH oxidases, and an uncoupled •NO synthase. Acute high-dose challenges with organic nitrates cause a similar loss of potency (tachyphylaxis), but with distinct pathomechanism. The differences among organic nitrates are highlighted regarding their potency to induce oxidative stress and subsequent tolerance and endothelial dysfunction. We also address pleiotropic effects of organic nitrates, for example, their capacity to stimulate antioxidant pathways like those demonstrated for PETN, all of which may prevent adverse effects in response to long-term therapy. Based on these considerations, we will discuss and present some preclinical data on how the nitrate of the future should be designed.
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Affiliation(s)
- Andreas Daiber
- The 2nd Medical Clinic, Medical Center of the Johannes Gutenberg University , Mainz, Germany
| | - Thomas Münzel
- The 2nd Medical Clinic, Medical Center of the Johannes Gutenberg University , Mainz, Germany
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Steven S, Münzel T, Daiber A. Exploiting the Pleiotropic Antioxidant Effects of Established Drugs in Cardiovascular Disease. Int J Mol Sci 2015; 16:18185-223. [PMID: 26251902 PMCID: PMC4581241 DOI: 10.3390/ijms160818185] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease is a leading cause of death and reduced quality of life worldwide. Arterial vessels are a primary target for endothelial dysfunction and atherosclerosis, which is accompanied or even driven by increased oxidative stress. Recent research in this field identified different sources of reactive oxygen and nitrogen species contributing to the pathogenesis of endothelial dysfunction. According to lessons from the past, improvement of endothelial function and prevention of cardiovascular disease by systemic, unspecific, oral antioxidant therapy are obviously too simplistic an approach. Source- and cell organelle-specific antioxidants as well as activators of intrinsic antioxidant defense systems might be more promising. Since basic research demonstrated the contribution of different inflammatory cells to vascular oxidative stress and clinical trials identified chronic inflammatory disorders as risk factors for cardiovascular events, atherosclerosis and cardiovascular disease are closely associated with inflammation. Therefore, modulation of the inflammatory response is a new and promising approach in the therapy of cardiovascular disease. Classical anti-inflammatory therapeutic compounds, but also established drugs with pleiotropic immunomodulatory abilities, demonstrated protective effects in various models of cardiovascular disease. However, results from ongoing clinical trials are needed to further evaluate the value of immunomodulation for the treatment of cardiovascular disease.
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Affiliation(s)
- Sebastian Steven
- Medical Clinic, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany.
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany.
| | - Thomas Münzel
- Medical Clinic, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany.
| | - Andreas Daiber
- Medical Clinic, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany.
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Jabs A, Oelze M, Mikhed Y, Stamm P, Kröller-Schön S, Welschof P, Jansen T, Hausding M, Kopp M, Steven S, Schulz E, Stasch JP, Münzel T, Daiber A. Effect of soluble guanylyl cyclase activator and stimulator therapy on nitroglycerin-induced nitrate tolerance in rats. Vascul Pharmacol 2015; 71:181-91. [DOI: 10.1016/j.vph.2015.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/20/2015] [Accepted: 03/25/2015] [Indexed: 01/06/2023]
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Münzel T, Gori T, Keaney JF, Maack C, Daiber A. Pathophysiological role of oxidative stress in systolic and diastolic heart failure and its therapeutic implications. Eur Heart J 2015; 36:2555-64. [PMID: 26142467 DOI: 10.1093/eurheartj/ehv305] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/15/2015] [Indexed: 02/07/2023] Open
Abstract
Systolic and diastolic myocardial dysfunction has been demonstrated to be associated with an activation of the circulating and local renin-angiotensin-aldosterone system (RAAS), and with a subsequent inappropriately increased production of reactive oxygen species (ROS). While, at low concentrations, ROS modulate important physiological functions through changes in cellular signalling and gene expression, overproduction of ROS may adversely alter cardiac mechanics, leading to further worsening of systolic and diastolic function. In addition, vascular endothelial dysfunction due to uncoupling of the nitric oxide synthase, activation of vascular and phagocytic membrane oxidases or mitochondrial oxidative stress may lead to increased vascular stiffness, further compromising cardiac performance in afterload-dependent hearts. In the present review, we address the potential role of ROS in the pathophysiology of myocardial and vascular dysfunction in heart failure (HF) and their therapeutic targeting. We discuss possible mechanisms underlying the failure of antioxidant vitamins in improving patients' prognosis, the impact of angiotensin-converting enzyme inhibitors or AT1 receptor blockers on oxidative stress, and the mechanism of the benefit of combination of hydralazine/isosorbide dinitrate. Further, we provide evidence supporting the existence of differences in the pathophysiology of HF with preserved vs. reduced ejection fraction and whether targeting mitochondrial ROS might be a particularly interesting therapeutic option for patients with preserved ejection fraction.
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Affiliation(s)
- Thomas Münzel
- 2nd Medical Clinic, Department of Cardiology, Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz 55131, Germany
| | - Tommaso Gori
- 2nd Medical Clinic, Department of Cardiology, Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz 55131, Germany
| | - John F Keaney
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Christoph Maack
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Andreas Daiber
- 2nd Medical Clinic, Department of Cardiology, Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz 55131, Germany
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Farag M, Mabote T, Shoaib A, Zhang J, Nabhan AF, Clark AL, Cleland JG. Hydralazine and nitrates alone or combined for the management of chronic heart failure: A systematic review. Int J Cardiol 2015; 196:61-9. [PMID: 26073215 DOI: 10.1016/j.ijcard.2015.05.160] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hydralazine (H) and nitrates (Ns), when combined, reduced morbidity and mortality in some trials of chronic heart failure (CHF). It is unclear whether either agent used alone provides similar benefits. We aimed to evaluate the effects of H and/or N in patients with CHF. METHODS A systematic review of randomised trials assessing the effects of H and N in CHF. For meta-analysis, only the endpoints of all-cause mortality and cardiovascular mortality were considered. RESULTS In seven trials evaluating H&N in 2626 patients, combination therapy reduced all-cause mortality (OR 0.72; 95% CI 0.55-0.95; p=0.02), and cardiovascular mortality (OR 0.75; 95% CI 0.57-0.99; p=0.04) compared to placebo. However, when compared to angiotensin converting enzyme inhibitors (ACEIs), combination therapy was associated with higher all-cause mortality (OR 1.35; 95% CI 1.03-1.76; p=0.03), and cardiovascular mortality (OR 1.37; 95% CI 1.04-1.81; p=0.03). For N alone, ten trials including 375 patients reported all-cause mortality and showed a trend to harm (13 deaths in those assigned to nitrates and 7 to placebo; OR 2.13; 95% CI 0.88-5.13; p=0.09). For H alone, three trials showed no difference in all-cause mortality compared to placebo (OR 0.96; 95% CI 0.37-2.47; p=0.93), and two trials suggested inferiority to ACEI (OR 2.28; 95% CI 1.03-5.04; p=0.04). CONCLUSIONS Compared to placebo, H&N reduces mortality in patients with CHF. Whether race or background therapy influences benefit is uncertain, but on direct comparison H&N appears inferior to ACEI. There is little evidence to support the use of either drug alone in CHF.
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Affiliation(s)
- Mohamed Farag
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull HU16 5JQ, UK.
| | - Thato Mabote
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull HU16 5JQ, UK
| | - Ahmad Shoaib
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull HU16 5JQ, UK
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull HU16 5JQ, UK
| | - Ashraf F Nabhan
- Postgraduate Medical School, Ain Shams University, Cairo, Egypt
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull HU16 5JQ, UK
| | - John G Cleland
- National Heart & Lung Institute, Imperial College, London, UK
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Probable Rare Case of Cholecystitis After Exposure to Supratherapeutic Doses of Hydralazine. J Pharm Technol 2015; 31:135-137. [DOI: 10.1177/8755122514558124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To report a rare case of cholecystitis in a patient who received supratherapeutic doses of hydralazine for 1 month. Case Summary: A 79-year-old woman was admitted with severe right upper quadrant abdominal pain. Three weeks prior, she suffered a similar episode and was told she had a buildup of sludge in her gall bladder. For the past month, she had inadvertently received 400 mg of hydralazine per day instead of 150 mg; she was also prescribed fenofibrate 145 mg daily. Her workup was remarkable only for a slightly elevated white blood cell count and gall bladder sludge and distention without common duct obstruction. She was diagnosed with cholecystitis and underwent a laporoscopic cholecystectomy within 72 hours of admission. She was subsequently discharged a day later with the corrected hydralazine dose, and she has not been readmitted to the hospital. Discussion: Hydralazine is a direct acting vasodilator that may also potentiate the effects of nitric oxide. Nitric oxide has been linked to decreased gall bladder motility in in vivo and in vitro studies. The Naranjo algorithm indicates that this is a probable adverse event of fenofibrate and of hydralazine; the Drug Interaction Probability Scale indicates that this case of cholecystitis was a possible result of the interaction between hydralazine and fenofibrate. Based on the time course of the patient’s medication use and symptoms, hydralazine is more likely to be the cause of her cholecystitis than her other medications. Conclusion: Clinicians should be aware that high doses of hydralazine may inhibit gall bladder motility and contribute to the buildup of bile sludge.
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Zakeri R, Levine JA, Koepp GA, Borlaug BA, Chirinos JA, LeWinter M, VanBuren P, Dávila-Román VG, de Las Fuentes L, Khazanie P, Hernandez A, Anstrom K, Redfield MM. Nitrate's effect on activity tolerance in heart failure with preserved ejection fraction trial: rationale and design. Circ Heart Fail 2015; 8:221-8. [PMID: 25605640 PMCID: PMC4304404 DOI: 10.1161/circheartfailure.114.001598] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/03/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Rosita Zakeri
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - James A Levine
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Gabriel A Koepp
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Barry A Borlaug
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Julio A Chirinos
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Martin LeWinter
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Peter VanBuren
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Victor G Dávila-Román
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Lisa de Las Fuentes
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Prateeti Khazanie
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Adrian Hernandez
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Kevin Anstrom
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Margaret M Redfield
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.).
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Bogaev RC, Meyers DE. Medical Treatment of Heart Failure and Coronary Heart Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ennezat PV, Stewart M, Samson R, Bouabdallaoui N, Maréchaux S, Banfi C, Bouvaist H, Le Jemtel TH. Editor's Choice-Recent therapeutic trials on fluid removal and vasodilation in acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 5:86-95. [PMID: 25414321 DOI: 10.1177/2048872614560504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/14/2014] [Indexed: 01/08/2023]
Abstract
Recent therapeutic trials regarding the management of acute heart failure (AHF) failed to demonstrate the efficacy of newer therapeutic modalities and agents. Low- versus high-dose and continuous administration of furosemide were shown not to matter. Ultrafiltration was not found to be more efficacious than sophisticated diuretic therapy including dose-adjusted intravenous furosemide and metolazone. Dopamine and nesiritide were not shown to be superior to current therapy. Tezosentan and tovalptan had no effect on mortality. The development of rolofylline was terminated due to adverse effect (seizures). Lastly, preliminary experience with serelaxin indicates a mortality improvement at six months that remains to be confirmed. The disappointing findings of these recent trials may reflect the lack of efficacy of newer therapeutic modalities and agents. Alternatively the disappointing findings of these recent trials may be in part due to methodological issues. The AHF syndrome is complex with many clinical phenotypes. Failure to match clinical phenotypes and therapeutic modalities is likely to be partly responsible for the disappointing findings of recent AHF trials.
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Affiliation(s)
- Pierre V Ennezat
- Cardiology Department, Centre Hospitalier Universitaire de Grenoble, France
| | - Merrill Stewart
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Rohan Samson
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nadia Bouabdallaoui
- Department of Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Paris, France
| | - Sylvestre Maréchaux
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Carlo Banfi
- Division of Cardiovascular Surgery and Geneva Hemodynamic Research Group, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Bouvaist
- Cardiology Department, Centre Hospitalier Universitaire de Grenoble, France
| | - Thierry H Le Jemtel
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
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White M, Patel K, Caldentey G, Deedwania P, Kheirbek R, Fletcher RD, Aban IB, Lo A, Aronow WS, Fonarow GC, Anker SD, Ahmed A. Racial differences in mortality in patients with advanced systolic heart failure: potential role of right ventricular ejection fraction. Int J Cardiol 2014; 177:255-60. [PMID: 25499389 DOI: 10.1016/j.ijcard.2014.09.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/16/2014] [Accepted: 09/20/2014] [Indexed: 11/18/2022]
Abstract
In Beta-Blocker Evaluation of Survival Trial (BEST) bucindolol significantly reduced mortality among Caucasians with systolic heart failure (HF) but not among African Americans. Whether this differential effect can be explained by racial differences in baseline characteristics has not been previously examined. Of the 2708 BEST participants, 627 were African Americans. Because African Americans were more likely to be younger and women, we used age-sex-adjusted hazard ratios (HR) and 95% confidence intervals (CI) to estimate their outcomes (vs. Caucasians). A step-wise multivariable-adjusted model using 24 baseline characteristics was used to identify variables associated with between-race outcome differences and propensity-matching was used to determine independence of associations. Age-sex-adjusted HR for all-cause mortality for African Americans during 2 years of mean follow-up was 1.27. African Americans were more likely to have lower right ventricular ejection fraction. African Americans had no association with mortality among propensity-matched patients. The higher risk of death among African Americans in BEST may in part be due to their lower RVEF which may in part explain the lack of response to bucindolol among these patients. Future studies need to examine the role of low RVEF on the effect of beta-blockers in patients with systolic HF.
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Affiliation(s)
- Michel White
- Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada.
| | - Kanan Patel
- University of California, San Francisco, CA, USA
| | - Guillem Caldentey
- Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Raya Kheirbek
- Veterans Affairs Medical Center, Washington, DC, USA
| | | | | | - Alexander Lo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Stefan D Anker
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, USA
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Münzel T, Steven S, Daiber A. Organic nitrates: update on mechanisms underlying vasodilation, tolerance and endothelial dysfunction. Vascul Pharmacol 2014; 63:105-13. [PMID: 25446162 DOI: 10.1016/j.vph.2014.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/15/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
Given acutely, organic nitrates, such as nitroglycerin (GTN), isosorbide mono- and dinitrates (ISMN, ISDN), and pentaerythrityl tetranitrate (PETN), have potent vasodilator and anti-ischemic effects in patients with acute coronary syndromes, acute and chronic congestive heart failure and arterial hypertension. During long-term treatment, however, side effects such as nitrate tolerance and endothelial dysfunction occur, and therapeutic efficacy of these drugs rapidly vanishes. Recent experimental and clinical studies have revealed that organic nitrates per se are not just nitric oxide (NO) donors, but rather a quite heterogeneous group of drugs considerably differing for mechanisms underlying vasodilation and the development of endothelial dysfunction and tolerance. Based on this, we propose that the term nitrate tolerance should be avoided and more specifically the terms of GTN, ISMN and ISDN tolerance should be used. The present review summarizes preclinical and clinical data concerning organic nitrates. Here we also emphasize the consequences of chronic nitrate therapy on the supersensitivity of the vasculature to vasoconstriction and on the increased autocrine expression of endothelin. We believe that these so far rather neglected and underestimated side effects of chronic therapy with at least GTN and ISMN are clinically important.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology and Angiology, University Medical Center, Mainz, Germany.
| | - Sebastian Steven
- Department of Cardiology and Angiology, University Medical Center, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology and Angiology, University Medical Center, Mainz, Germany
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den Uil CA, Brugts JJ. Impact of Intravenous Nitroglycerin in the Management of Acute Decompensated Heart Failure. Curr Heart Fail Rep 2014; 12:87-93. [DOI: 10.1007/s11897-014-0230-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Xanthine oxidase is an important source of reactive oxygen species; so, it may play a role in the pathogenesis of endothelium dysfunction and its consequences. Allopurinol, a purine analog, is a famous xanthine oxidase inhibitor. This study aimed to investigate possible effects of allopurinol on nitroglycerin tolerance, vasoconstriction, and vasorelaxation in rat aortic ring. Using thoracic aortic rings obtained from male Wistar rats, the effect of allopurinol was examined on nitroglycerin-induced tolerance. In addition, changes of vasoconstriction (by using KCl and phenylephrine) and vasorelaxation (by using carbachol, sodium nitroprusside, and nitroglycerin) were also measured and compared between tissues treated with and without allopurinol. All 3 concentrations of allopurinol (50, 100, and 150 μM) significantly acted against the development of nitroglycerin-induced tolerance in comparison with controls. In terms of vasoconstriction and vasorelaxation, the effect of allopurinol was significant only on carbachol-induced (endothelium related) vasorelaxation in a dose-dependent manner. In conclusion, although allopurinol had no significant effect on the contractile response of the aorta, in accord with the previous data, it significantly intensified endothelium-dependent vasodilation. The inhibitory effect of allopurinol against the development of nitrate-induced tolerance may suggest its clinical benefit and is worth to be studied more extensively.
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Albarwani S, Al-Siyabi S, Tanira MO. Prehypertension: Underlying pathology and therapeutic options. World J Cardiol 2014; 6:728-43. [PMID: 25228952 PMCID: PMC4163702 DOI: 10.4330/wjc.v6.i8.728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/08/2014] [Accepted: 06/14/2014] [Indexed: 02/06/2023] Open
Abstract
Prehypertension (PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease (CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system (RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the potential pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the "Polypill" in prehypertensive subjects to ascertain its potential in delaying (or preventing) CVD associated with raised blood pressure in the presence of other risk factors.
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Affiliation(s)
- Sulayma Albarwani
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Sultan Al-Siyabi
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Musbah O Tanira
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
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Abstract
The origins of the hydralazine/isosorbide dinitrate (H+ISDN) combination therapy are rooted in the first large-scale clinical trial in heart failure: V-HeFT I. Initially utilized for the balanced vasodilatory properties of each drug, we now know there is "more to the story." In fact, the maintenance of the nitroso-redox balance may be the true mechanism of benefit. Since the publication of V-HeFT I 30 years ago, H+ISDN has been the subject of much discussion and debate. Regardless of the many controversies surrounding H+ISDN, one thing is clear: therapy is underutilized and many patients who could benefit never receive the drugs. Ongoing physician and patient education are mandatory to improve the rates of H+ISDN use.
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Affiliation(s)
- Robert T Cole
- Division of Cardiology, Emory University, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Divya Gupta
- Division of Cardiology, Emory University, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Javed Butler
- Division of Cardiology, Emory University, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
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Ferdinand KC, Elkayam U, Mancini D, Ofili E, Piña I, Anand I, Feldman AM, McNamara D, Leggett C. Use of isosorbide dinitrate and hydralazine in African-Americans with heart failure 9 years after the African-American Heart Failure Trial. Am J Cardiol 2014; 114:151-9. [PMID: 24846808 DOI: 10.1016/j.amjcard.2014.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
The 2013 American College of Cardiology Foundation/American Heart Association guidelines recommend combined isosorbide dinitrate (ISDN) and hydralazine to reduce mortality and morbidity for African-Americans with symptomatic heart failure (HF) and reduced ejection fraction, currently receiving optimal medical therapy (class I, level A). Nitrates can alleviate HF symptoms, but continuous use is limited by tolerance. Hydralazine may mitigate nitrate tolerance, and the ISDN-hydralazine combination in the Vasodilators in Heart Failure Trial (V-HeFT) I improved survival and exercise tolerance in men with dilated cardiomyopathy or HF with reduced ejection fraction, most notably in self-identified black participants. In the subsequent V-HeFT II, survival was greater with enalapril than with ISDN-hydralazine in the overall cohort, but mortality rate was similar in the enalapril and ISDN-hydralazine groups in the self-identified black patients. Consequently, in the African-American Heart Failure Trial (A-HeFT) in self-identified black patients with symptomatic HF, adding a fixed-dose combination ISDN-hydralazine to modern guideline-based care improved outcomes versus placebo, including all-cause mortality, and led to early trial termination. Hypertension underlies HF, especially in African-Americans; the A-HeFT and its substudies demonstrated not only improvements in echocardiographic parameters, morbidity, and mortality but also a decrease in hospitalizations, potentially affecting burgeoning HF health-care costs. Genetic characteristics may, therefore, determine response to ISDN-hydralazine, and the Genetic Risk Assessment in Heart Failure substudy demonstrated important hypothesis-generating pharmacogenetic data.
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Knorr M, Hausding M, Pfeffer A, Jurk K, Jansen T, Schwierczek K, Oelze M, Kröller-Schön S, Schulz E, Wenzel P, Gori T, Burgin K, Sartor D, Scherhag A, Münzel T, Daiber A. In vitro and in vivo characterization of a new organic nitrate hybrid drug covalently bound to pioglitazone. Pharmacology 2014; 93:203-15. [PMID: 24923291 DOI: 10.1159/000361052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Organic nitrates represent a group of nitrovasodilators that are clinically used for the treatment of ischemic heart disease. The new compound CLC-3000 is an aminoethyl nitrate (AEN) derivative of pioglitazone, a thiazolidinedione antidiabetic agent combining the peroxisome proliferator-activated receptor γ agonist activity of pioglitazone with the NO-donating activity of the nitrate moiety. METHODS In vitro and in vivo characterization was performed by isometric tension recording, platelet function, bleeding time and detection of oxidative stress. RESULTS In vitro, CLC-3000 displayed more potent vasodilation than pioglitazone alone or classical nitrates. In vitro, some effects on oxidative stress parameters were observed. Authentic AEN or the AEN-containing linker CLC-1275 displayed antiaggregatory effects. In vivo treatment with CLC-3000 for 7 days did neither induce endothelial dysfunction nor nitrate tolerance nor oxidative stress. Acute or chronic administration of AEN increased the tail vein bleeding time in mice. CONCLUSION In summary, the results of these studies demonstrate that CLC-3000 contains a vasodilative and antithrombotic activity that is not evident with pioglitazone alone, and that 7 days of exposure in vivo showed no typical signs of nitrate tolerance, endothelial dysfunction or other safety concerns in Wistar rats.
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Affiliation(s)
- Maike Knorr
- Molekulare Kardiologie, II. Medizinische Klinik und Poliklinik, Klinikum der Johannes Gutenberg-Universität Mainz, Mainz, Germany
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Aldini G, Carini M, Yeum KJ, Vistoli G. Novel molecular approaches for improving enzymatic and nonenzymatic detoxification of 4-hydroxynonenal: toward the discovery of a novel class of bioactive compounds. Free Radic Biol Med 2014; 69:145-56. [PMID: 24456906 DOI: 10.1016/j.freeradbiomed.2014.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/18/2022]
Abstract
4-Hydroxy-trans-2-nonenal (HNE), an α,β-unsaturated aldehyde generated endogenously by the radical-mediated peroxidation of ω-6 polyunsaturated fatty acids, is a bioactive molecule acting in several physiopathological mechanisms and most of its activity is due to the covalent modification of biomolecules. Although at low and physiological levels HNE acts as an endogenous signaling molecule, a growing bulk of evidence indicates that at high and toxic concentrations, HNE is involved in the onset and propagation of several human diseases. To get more conclusive evidence of HNE as a pathogenetic factor, a pharmacological tool able to inhibit the HNE-induced cellular response is required. Such compound is currently not available, although several molecular strategies have so far been reported with the aim of inhibiting HNE formation or catalyzing its removal. Although most of these are not selective, such strategies have been found to induce several biological responses and would merit further investigation. In this review the various strategies are reported and discussed together with their limits and potentials.
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Affiliation(s)
- Giancarlo Aldini
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Marina Carini
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, 20133 Milan, Italy
| | - Kyung-Jin Yeum
- Division of Food Bioscience, College of Biomedical and Health Sciences, Konkuk University, Chungju-Si, Republic of Korea
| | - Giulio Vistoli
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, 20133 Milan, Italy
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Cole RT, Gheorghiade M, Georgiopoulou VV, Gupta D, Marti CN, Kalogeropoulos AP, Butler J. Reassessing the use of vasodilators in heart failure. Expert Rev Cardiovasc Ther 2014; 10:1141-51. [DOI: 10.1586/erc.12.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Daugherty A, Lu H. Diverse contributions from the initial discovery of mechanisms of angiotensin II-induced oxidation in smooth muscle cells. Circ Res 2013; 113:1283-5. [PMID: 24311616 DOI: 10.1161/circresaha.113.302753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan Daugherty
- From Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY
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