Valsartan in the treatment of heart attack survivors

Response surface methodology combined Box-Behnken design optimized green kinetic spectrophotometric and HPLC methods to quantify angiotensin receptor blocker valsartan in pharmaceutical formulations

The high-performance liquid chromatographic (HPLC) and kinetic spectrophotometric methods were established to compute valsartan (VAL) in pharmaceutical formulations. The spectrophotometric procedures adopted initial rate, fixed time, and equilibrium strategies to assess VAL. The method was based on the carboxylic acid group of the oxidized VAL with a mixture of potassium iodate (KIO₃) and potassium iodide (KI) at room temperature, producing a stable, yellow-coloured absorb at 352 nm. The critical parameters were optimized using green process optimization methodology such as Box-Behnken design (BBD) which belongs to response surface methodology (RSM). After the screening, experiments identified them as significant, and then three crucial factors were optimised: KI volume, KIO₃ volume, and reaction time against response as absorbance. The HPLC procedure was also optimized based on the desirability function on RSM-BBD. The parameters such as pH, methanol (%), and flow rate (ml/min) were optimized with the best responses: peak area, symmetry, and theoretical plates. The linearity of spectrophotometric and HPLC methods was within the range of 2-24 and 0.25-11.25 µg/ml, respectively. The developed procedures produced excellent accuracy and precision. The design of the experiment (DoE) setting explained and discussed the individual steps and the importance of independent and dependent variables used to develop the model and optimization. The method was validated as per the International Conference on Harmonization (ICH) guidelines. Furthermore, Youden's robustness study was applied with factorial combinations of the preferred analytical parameters and explored their influence with alternative conditions. The analytical Eco-Scale score was calculated and was found a better option as green methods to quantify VAL. The results were reproducible with the analysis completed with biological fluid and wastewater samples.

Rapid methylation of valsartan in human plasma using evaporative derivatization reagent to improve its sensitivity in MALDI-TOF mass spectrometry

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a rapid and low-solvent-consumption technique. However, almost every mass in the low mass-to-charge-ratio region of the mass spectrum appears as strongly fluctuating matrix background signals. Thus, it is difficult to identify small molecules using this technique. In this study, we used methanol to methylate valsartan, an angiotensin II receptor blocker that is commonly used to treat high blood pressure and heart failure. The methylation derivatization of valsartan enhanced the detection sensitivity and transformed the detection m/z ratio. The liquid-phase microextraction of valsartan in human plasma (20 μL) was achieved by acidifying valsartan with HCl aqueous solution and extracting it with toluene. An acetyl chloride/anhydrous methanol mixture was added for methylation derivatization, which was completed within 30 min at 30 °C. Finally, the residue was re-dissolved in irbesartan methanolic solution, which together with the matrix 2-mercaptobenzothiazole was spotted on an AnchorChip target plate for MALDI-TOF MS analysis. Liquid-phase microextraction was performed and the methylation-derivatization parameters were investigated. The valsartan calibration range was 0.2-10 μg mL^-1 with good linearity in human plasma. In the within- and between-run analyses, the relative standard deviation and relative error were both <11.32%. This method was successfully applied to determine the valsartan concentration in the plasma of 10 patients with hypertension.

Ecotoxicological impact of the antihypertensive valsartan on earthworms, extracellular enzymes and soil bacterial communities

The use of reclaimed water in agriculture represents a promising alternative to relieve pressure on freshwater supplies, especially in arid or semiarid regions facing water scarcity. However, this implies introducing micropollutants such as pharmaceutical residues into the environment. The fate and the ecotoxicological impact of valsartan, an antihypertensive drug frequently detected in wastewater effluents, were evaluated in soil-earthworm microcosms. Valsartan dissipation in the soil was concomitant with valsartan acid formation. Although both valsartan and valsartan acid accumulated in earthworms, no effect was observed on biomarkers of exposure (acetylcholinesterase, glutathione S-transferase and carboxylesterase activities). The geometric mean index of soil enzyme activity increased in the soils containing earthworms, regardless of the presence of valsartan. Therefore, earthworms increased soil carboxylesterase, dehydrogenase, alkaline phosphatase, β-glucosidase, urease and protease activities. Although bacterial richness significantly decreased following valsartan exposure, this trend was enhanced in the presence of earthworms with a significant impact on both alpha and beta microbial diversity. The operational taxonomic units involved in these changes were related to four (Proteobacteria, Bacteroidetes, Actinobacteria and Firmicutes) of the eight most abundant phyla. Their relative abundances significantly increased in the valsartan-treated soils containing earthworms, suggesting the presence of potential valsartan degraders. The ecotoxicological effect of valsartan on microbes was strongly altered in the earthworm-added soils, hence the importance of considering synergistic effects of different soil organisms in the environmental risk assessment of pharmaceutical active compounds.

Oleuropein prevents the development of experimental autoimmune myocarditis in rats

Oleuropein (OLE) is a natural secoiridoid that is derived from Olea europaea. OLE possesses cardioprotective effects in experimental models of hypertension, myocardial infarction, atherosclerosis and hyperlipidaemia. In the present study, the effects of OLE on experimental autoimmune myocarditis (EAM) were evaluated. EAM in rats were induced by subcutaneous injections of porcine cardiac myosin. Cardiac function parameters, myocardial pathology, myocardial inflammatory cell infiltration and nuclear factor kappa-B (NF-κB) expression were measured. Our data showed that the postmyocarditis rats exhibited increased left ventricular end systolic diameters, left ventricular end diastolic diameters, left ventricular end-diastolic pressures (LVEDP), and decreased ejection fractions. However, OLE significantly suppressed these changes in EAM rats. Histological analysis revealed that myosin induced miliary foci of discolouration on endocardial surfaces and extensive myocardial injuries with inflammatory cell infiltration were significantly improved by OLE therapy. A definitive positive correlation between the histological scores and LVEDP was observed. Moreover, OLE inhibited CD4⁺, CD8⁺ cells and macrophage infiltration in myocardium and decreased the serum production of tumour necrosis factor-a (TNF-a), interleukin-1β (IL-1β) and IL-6 in EAM rats. Expectedly, the myocardial levels of NF-κB p65, p-IκBa, IKKa were significantly attenuated by OLE, indicating the inhibitory effects of OLE on the NF-κB pathway. Furthermore, OLE decreased the myocardial expressions of phosphorylated-p38 MAPK, phosphorylated-ERK, and did not change the levels of p38 MAPK and ERK in EAM rats. Collectively, our results suggest that OLE effectively prevents the development of myocarditis, at least in part, by inhibiting the MAPKs and NF-κB mediated inflammatory responses.

Valsartan Upregulates Kir2.1 in Rats Suffering from Myocardial Infarction via Casein Kinase 2

Purpose

Myocardial infarction (MI) results in an increased susceptibility to ventricular arrhythmias, due in part to decreased inward-rectifier K+ current (IK1), which is mediated primarily by the Kir2.1 protein. The use of renin-angiotensin-aldosterone system antagonists is associated with a reduced incidence of ventricular arrhythmias. Casein kinase 2 (CK2) binds and phosphorylates SP1, a transcription factor of KCNJ2 that encodes Kir2.1. Whether valsartan represses CK2 activation to ameliorate IK1 remodeling following MI remains unclear.

Methods

Wistar rats suffering from MI received either valsartan or saline for 7 days. The protein levels of CK2 and Kir2.1 were each detected via a Western blot analysis. The mRNA levels of CK2 and Kir2.1 were each examined via quantitative real-time PCR.

Results

CK2 expression was higher at the infarct border; and was accompanied by a depressed IK1/Kir2.1 protein level. Additionally, CK2 overexpression suppressed KCNJ2/Kir2.1 expression. By contrast, CK2 inhibition enhanced KCNJ2/Kir2.1 expression, establishing that CK2 regulates KCNJ2 expression. Among the rats suffering from MI, valsartan reduced CK2 expression and increased Kir2.1 expression compared with the rats that received saline treatment. In vitro, hypoxia increased CK2 expression and valsartan inhibited CK2 expression. The over-expression of CK2 in cells treated with valsartan abrogated its beneficial effect on KCNJ2/Kir2.1.

Conclusions

AT1 receptor antagonist valsartan reduces CK2 activation, increases Kir2.1 expression and thereby ameliorates IK1 remodeling after MI in the rat model.

Valsartan ameliorates KIR2.1 in rats with myocardial infarction via the NF-κB-miR-16 pathway

BACKGROUND

MicroRNAs have an important role in regulating arrhythmogenesis. MicroRNA-16 (miR-16) is predicted to target KCNJ2. The regulation of miR-16 is primarily due to NF-κB. Whether valsartan could downregulate miR-16 via the inhibition of NF-κB after MI and whether miR-16 targets KCNJ2 remain unclear.

METHODS

MI rats received valsartan or saline for 7days. The protein levels of NF-κB p65, inhibitor κBα (IκBα), and Kir2.1 were detected by Western blot analysis. The mRNA levels of Kir2.1 and miR-16 were examined by quantitative real-time PCR. Whole cell patch-clamp techniques were applied to record IK1.

RESULTS

MiR-16 expression was higher in the infarct border, and was accompanied by a depressed IK1/KIR2.1 level. Additionally, miR-16 overexpression suppressed KCNJ2/KIR2.1 expression. In contrast, miR-16 inhibition or binding-site mutation enhanced KCNJ2/KIR2.1 expression, establishing KCNJ2 as a miR-16 target. In the MI rats, compared to saline treatment, valsartan reduced NF-κB p65 and miR-16 expression and increased IκBα and Kir2.1 expression. In vitro, angiotensin II increased miR-16 expression and valsartan inhibited it. Overexpressing miR-16 in cells treated with valsartan abrogated its beneficial effect on KCNJ2/Kir2.1. NF-κB activation directly upregulates miR-16 expression.

CONCLUSIONS

miR-16 controls KCNJ2 expression, and valsartan ameliorates Kir2.1 after MI partly depending on the NF-κB-miR-16 pathway.

Clinical effectiveness of telmisartan alone or in combination therapy for controlling blood pressure and vascular risk in the elderly

Elderly patients (age ≥ 65 years) with hypertension are at high risk for vascular complications, especially when diabetes is present. Antihypertensive drugs that inhibit the renin-angiotensin system have been shown to be effective for controlling blood pressure in adult and elderly patients. Importantly, renin-angiotensin system inhibitors were shown to have benefits beyond their classic cardioprotective and vasculoprotective effects, including reducing the risk of new-onset diabetes and associated cardiovascular effects. The discovery that the renin-angiotensin system inhibitor and angiotensin II type 1 (AT(1)) receptor blocker (ARB), telmisartan, can selectively activate the peroxisome proliferator-activated receptor-γ (PPARγ, an established antidiabetic drug target) provides the unique opportunity to prevent and treat cardiovascular complications in high-risk elderly patients with hypertension and new-onset diabetes. Two large clinical trials, ONTARGET (Ongoing Telmisartan Alone in combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized AssessmeNt Study in ACE-I iNtolerant subjects with cardiovascular disease) have assessed the cardioprotective and antidiabetic effects of telmisartan. The collective data suggest that telmisartan is a promising drug for controlling hypertension and reducing vascular risk in high-risk elderly patients with new-onset diabetes.

Heart failure in the elderly: advances and challenges

The elderly population (age > or =65 years) is increasing, and with it the prevalence of heart failure and associated morbidity, hospitalizations and costs. Despite advances, clinical trial data on heart failure therapy exclusively for elderly patients are lacking. However, trials of therapy for heart failure with left ventricular systolic dysfunction or low ejection fraction in primarily non-elderly patients showed mortality benefit in elderly patients. By contrast, trials for heart failure with normal left ventricular systolic function or preserved ejection fraction have not shown mortality benefit in elderly or non-elderly patients. Heart failure pharmacotherapy in the elderly is challenging; it needs to be individualized and consider aging-specific changes in physiology, drug metabolism, drug pharmacokinetics and tolerance, comorbidities, polypharmacy and drug-drug interactions that can contribute to adverse effects. More research into the biology of aging and clinical trials in elderly patients may lead to the discovery of new therapies for heart failure in the elderly.

High-affinity interaction of sartans with H+/peptide transporters

Sartans are very effective drugs for treatment of hypertension, heart failure, and other cardiovascular disorders. They antagonize the effects of angiotensin II at the AT(1) receptor and display p.o. bioavailability rates of 13 to 80%. Because some sartans sterically resemble dipeptide derivatives, we investigated whether they are transported by peptide transporters. We first assessed the effects of sartans on [(14)C]glycylsarcosine uptake into Caco-2 cells expressing H(+)/peptide transporter (PEPT) 1 and into SKPT cells expressing PEPT2. Losartan, irbesartan, valsartan, and eprosartan inhibited [glycine-1-(14)C]glycylsarcosine ([(14)C]Gly-Sar) uptake into Caco-2 cells in a competitive manner with K(i) values of 24, 230, 390, and >1000 microM. Losartan and valsartan also strongly inhibited the total transepithelial flux of [(14)C]Gly-Sar across Caco-2 cell monolayers. In SKPT cells, [(14)C]Gly-Sar uptake was inhibited with K(i) values of 2.2 microM (losartan), 65 microM (irbesartan), 260 microM (valsartan), and 490 microM (eprosartan). We determined by the two-electrode voltage-clamp technique whether the compounds elicited transport currents by PEPT1 or PEPT2 when expressed in Xenopus laevis oocytes. No currents were observed for any of the sartans, but the compounds strongly and reversibly inhibited peptide-induced currents. Uptake of valsartan, losartan, and cefadroxil was quantified in HeLa cells after heterologous expression of human PEPT1 (hPEPT1). In contrast to cefadroxil, no PEPT1-specific uptake of valsartan and losartan was found. We conclude that the sartans tested in this study display high-affinity interaction with PEPTs but are not transported themselves. However, they strongly inhibit hPEPT1-mediated uptake of dipeptides and cefadroxil.

Valsartan reverses post-translational modifications of the δ-subunit of ATP synthase duringin vivo canine reperfused myocardial infarction

To determine whether reperfused myocardial infarction (RMI) induces PTM of the delta-subunit of the mitochondrial metabolic enzyme ATP synthase (ATP/delta) in the ischemic zone (IZ) and whether this can be reversed by the angiotensin II type 1 receptor (AT(1)R) blocker valsartan, we applied a pharmaco-proteomics approach in canine RMI hearts with or without valsartan pretreatment. Using the 2-DE technique, we identified differential regional expression of ATP/delta in the IZ compared to the non-ischemic zone (NIZ), with an approximately 2-fold increase in the IZ that was normalized by valsartan. Furthermore in the IZ, RMI triggered S-nitrosylation of cysteine-100, nitration of the two tyrosines 88 and 225, and hydroxylation of lysine-182 in ATP/delta followed by its myristoylation. Importantly, valsartan abolished these modifications of ATP/delta in the IZ, triggered phosphorylation of serine-76 in both the IZ and NIZ, and decreased necrosis, apoptosis, left ventricular dysfunction and remodeling. Thus, AT(1)R-blocker-induced cardioprotection during RMI is associated with phosphorylation of ATP/delta and inhibition of nitric oxide-related chemical modifications such as S-nitrosylation, nitration and hydroxylation. Targeting specific PTMs during RMI, such as those of ATP/delta with AT(1)R blockade, might be a potentially powerful novel therapeutic approach. However, the identification of S-nitrosylation was putative and requires MS/MS verification.