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Liao Y, Du X, Fu Y, Liu L, Wei J, An Q, Luo X, Gao F, Jia S, Chang Y, Guo M, Liu H. Mechanism of traditional Chinese medicine in treating overactive bladder. Int Urol Nephrol 2023; 55:489-501. [PMID: 36479677 PMCID: PMC9957912 DOI: 10.1007/s11255-022-03434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Overactive bladder syndrome (OAB) has made increasing progress in mechanism and treatment research. Traditional Chinese medicine (TCM) is a common complementary therapy for OAB, and it has been found to be effective. However, the intervention mechanism of TCM in the treatment of OAB is still unclear. The aim of this review is to consolidate the current knowledge about the mechanism of TCM: acupuncture, moxibustion, herbs in treating OAB, and the animal models of OAB commonly used in TCM. Finally, we put forward the dilemma of TCM treatment of OAB and discussed the insufficiency and future direction of TCM treatment of OAB.
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Affiliation(s)
- Yuxiang Liao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Capital Medical University, Beijing, People's Republic of China
| | - Xin Du
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Capital Medical University, Beijing, People's Republic of China
| | - Yuanbo Fu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Capital Medical University, Beijing, People's Republic of China
| | - Lu Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Capital Medical University, Beijing, People's Republic of China
| | - Jiangyan Wei
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Capital Medical University, Beijing, People's Republic of China
| | - Qi An
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xuanzhi Luo
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Fan Gao
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Shuhan Jia
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Ying Chang
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Mengxi Guo
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Huilin Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Capital Medical University, Beijing, People's Republic of China.
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Myorelaxant action of fluorine-containing pinacidil analog, flocalin, in bladder smooth muscle is mediated by inhibition of L-type calcium channels rather than activation of KATP channels. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:585-92. [PMID: 26976335 DOI: 10.1007/s00210-016-1228-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
Flocalin (FLO) is a new ATP-sensitive K(+) (KATP) channel opener (KCO) derived from pinacidil (PIN) by adding fluorine group to the drug's structure. FLO acts as a potent cardioprotector against ischemia-reperfusion damage in isolated heart and whole animal models primarily via activating cardiac-specific Kir6.2/SUR2A KATP channels. Given that FLO also confers relaxation on several types of smooth muscles and can partially inhibit L-type Ca(2+) channels, in this study, we asked what is the mechanism of FLO action in bladder detrusor smooth muscle (DSM). The actions of FLO and PIN on contractility of rat and guinea pig DSM strips and membrane currents of isolated DSM cells were compared by tensiometry and patch clamp. Kir6 and SUR subunit expression in rat DSM was assayed by reverse transcription PCR (RT-PCR). In contrast to PIN (10 μM), FLO (10 μM) did not produce glibenclamide-sensitive DSM strips' relaxation and inhibition of spontaneous and electrically evoked contractions. However, FLO, but not PIN, inhibited contractions evoked by high K(+) depolarization. FLO (40 μM) did not change the level of isolated DSM cell's background K(+) current, but suppressed by 20 % L-type Ca(2+) current. Determining various Kir6 and SUR messenger RNA (mRNA) expressions in rat DSM by RT-PCR indicated that dominant KATP channel in rat DSM is of vascular type involving association of Kir6.1 and SUR2B subunits. Myorelaxant effects of FLO in bladder DSM are explained by partial blockade of L-type Ca(2+) channel-mediated Ca(2+) influx rather than by hyperpolarization associated with increased K(+) permeability. Thus, insertion of fluorine group in PIN's structure made the drug more discriminative between Kir6.2/SUR2A cardiac- and Kir6.1/SUR2B vascular-type KATP channels and rendered it partial L-type Ca(2+) channel-blocking potency.
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Petkov GV. Role of potassium ion channels in detrusor smooth muscle function and dysfunction. Nat Rev Urol 2011; 9:30-40. [PMID: 22158596 DOI: 10.1038/nrurol.2011.194] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Contraction and relaxation of the detrusor smooth muscle (DSM), which makes up the wall of the urinary bladder, facilitates the storage and voiding of urine. Several families of K(+) channels, including voltage-gated K(+) (K(V)) channels, Ca(2+)-activated K(+) (K(Ca)) channels, inward-rectifying ATP-sensitive K(+) (K(ir), K(ATP)) channels, and two-pore-domain K(+) (K(2P)) channels, are expressed and functional in DSM. They control DSM excitability and contractility by maintaining the resting membrane potential and shaping the action potentials that determine the phasic nature of contractility in this tissue. Defects in DSM K(+) channel proteins or in the molecules involved in their regulatory pathways may underlie certain forms of bladder dysfunction, such as overactive bladder. K(+) channels represent an opportunity for novel pharmacological manipulation and therapeutic intervention in human DSM. Modulation of DSM K(+) channels directly or indirectly by targeting their regulatory mechanisms has the potential to control urinary bladder function. This Review summarizes our current state of knowledge of the functional role of K(+) channels in DSM in health and disease, with special emphasis on current advancements in the field.
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Affiliation(s)
- Georgi V Petkov
- Department of Pharmaceutical and Biomedical Sciences, South Carolina College of Pharmacy, University of South Carolina, Coker Life Sciences Building, Room 609D, 715 Sumter Street, Columbia, SC 29208, USA.
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Huggins ME, Bhatia NN, Ostergard DR. Urinary incontinence: newer pharmacotherapeutic trends. Curr Opin Obstet Gynecol 2003; 15:419-27. [PMID: 14501246 DOI: 10.1097/00001703-200310000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Urinary incontinence is an under-reported epidemic with profound effects on quality of life. With recent pharmacologic advances, the belief that incontinence is an inevitable part of aging should be abandoned. Because many patients are unaware of curative options, they fail to report their symptoms and increase their risk of developing associated comorbid disease. Failure to diagnose and treat this disease in a timely manner increases society's economic burden associated with incontinence. RECENT FINDINGS Pharmacologic treatment of urge incontinence previously had limited treatment success because efficacious drugs were poorly tolerated, resulting in low patient compliance. Tolerance continues to be improved due to innovative new drugs and alternative delivery systems. While previous pharmacologic management of mild stress incontinence consisted of off-label agents with limited effectiveness, newly introduced drug therapy adds a viable, nonsurgical option for women with stress incontinence. SUMMARY The goal of this review is to update the clinician on the efficacy and tolerability of established and investigational pharmacologic modalities of therapy.
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Affiliation(s)
- Melissa E Huggins
- University of California, Irvine College of Medicine, Irvine, California, USA.
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Herrera GM, Pozo MJ, Zvara P, Petkov GV, Bond CT, Adelman JP, Nelson MT. Urinary bladder instability induced by selective suppression of the murine small conductance calcium-activated potassium (SK3) channel. J Physiol 2003; 551:893-903. [PMID: 12813145 PMCID: PMC2343290 DOI: 10.1113/jphysiol.2003.045914] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Accepted: 06/12/2003] [Indexed: 01/13/2023] Open
Abstract
Small conductance, calcium-activated potassium (SK) channels have an important role in determining the excitability and contractility of urinary bladder smooth muscle. Here, the role of the SK isoform SK3 was examined by altering expression levels of the SK3 gene using a mouse model that conditionally overexpresses SK3 channels (SK3T/T). Prominent SK3 immunostaining was found in both the smooth muscle (detrusor) and urothelium layers of the urinary bladder. SK currents were elevated 2.4-fold in isolated myocytes from SK3T/T mice. Selective suppression of SK3 expression by dietary doxycycline (DOX) decreased SK current density in isolated myocytes, increased phasic contractions of isolated urinary bladder smooth muscle strips and exposed high affinity effects of the blocker apamin of the SK isoforms (SK1-3), suggesting an additional participation from SK2 channels. The role of SK3 channels in urinary bladder function was assessed using cystometry in conscious, freely moving mice. The urinary bladders of SK3T/T had significantly greater bladder capacity, and urine output exceeded the infused saline volume. Suppression of SK3 channel expression did not alter filling pressure, threshold pressure or bladder capacity, but micturition pressure was elevated compared to control mice. However, SK3 suppression did eliminate excess urine production and caused a marked increase in non-voiding contractions. The ability to examine bladder function in mice in which SK3 channel expression is selectively altered reveals that these channels have a significant role in the control of non-voiding contractions in vivo. Activation of these channels may be a therapeutic approach for management of non-voiding contractions, a condition which characterizes many types of urinary bladder dysfunctions including urinary incontinence.
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Affiliation(s)
- Gerald M Herrera
- Department of Pharmacology, University of Vermont, Burlington 05405-0068, USA
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Abstract
OBJECTIVES To review the current pharmacologic options for treatment of the overactive bladder and to describe potential therapies on the horizon. METHODS The literature on the clinical efficacy and safety of the currently available agents is described. RESULTS According to the guidelines issued by the Agency for Health Care Policy and Research (AHCPR), anticholinergic agents should be the first-line pharmacologic therapy for patients with detrusor instability. Oxybutynin is the anticholinergic of choice for this indication, whereas propantheline is the second-line therapy. Although calcium antagonists have been investigated, the one such drug introduced for the treatment of overactive bladder (terodiline) was withdrawn from the market because of a risk of cardiac arrhythmia. Studies of potassium channel openers have found either a lack of clinical efficacy or an unacceptable level of side effects. Alpha-adrenergic antagonists may be useful for decreasing bladder overactivity in patients who have autonomous bladders as the result of conditions such as spinal cord injury. Tricyclic antidepressants (particularly imipramine) may be effective in decreasing bladder contractility, although the AHCPR guidelines caution that these drugs should be reserved for use in carefully evaluated patients. Future developments in the treatment of detrusor overactivity are likely to occur in 3 categories: drugs that affect peripheral excitatory mechanisms, drugs that inhibit afferent mechanisms, and drugs that affect more central actions at either the ganglionic, spinal cord, or supraspinal level. CONCLUSIONS Although pharmacologic management of the overactive bladder has progressed little in the past 10 years, the future may hold the promise of more effective therapies.
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Affiliation(s)
- A J Wein
- Division of Urology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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Edwards G, Weston AH. Recent advances in potassium channel modulation. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1997; 49:93-121. [PMID: 9388385 DOI: 10.1007/978-3-0348-8863-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Edwards
- School of Biological Sciences, University of Manchester, UK
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Hedlund H. Potassium channel openers for treatment of bladder hyperactivity. Urologia 1996. [DOI: 10.1177/039156039606300406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The potassium (K+) channel openers induce hyperpolarization by ATP-sensitive K+ channels. This group of compounds has been demonstrated to effectively relax the human detrusor and reduce bladder hyperactivity in obstructed rats. In patients with overactive bladders, oral administration and intravenous infusion of different K+ channel openers were without significant effect on urodynamic variables. In conscious dogs, a new K+ channel opener was found to increase bladder compliance with reduced micturition frequency. K+ channel openers have an interesting potential for the treatment of bladder hyperactivity, but development of new selective compounds with further clinical experience are demanded.
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Affiliation(s)
- H. Hedlund
- Institute of Surgery - Bergen University - Bergen (Norway)
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Davies MP, McCurrie JR, Wood D. Comparative effects of K+ channel modulating agents on contractions of rat intestinal smooth muscle. Eur J Pharmacol 1996; 297:249-56. [PMID: 8666057 DOI: 10.1016/0014-2999(95)00740-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The effects of six K+ channel openers were investigated on contractions of the rat ileum longitudinal muscle-myenteric plexus preparation elicited by electrical field stimulation and by K+. Levcromakalim, pinacidil, RP 49356 (N-methyl-2-(3 pyridyl)-tetrahydrothiopyran-2-carbothioamide-1-oxide) and SDZ PCO 400 ((3S,4R)-3, 4-dihydro-3-hydroxy-2, 2-dimethyl-4-[(3-oxo-1-cyclopenten-1-yl)oxy]-2H-1-benzopyran-6-car bonitrile) completely abolished contractions elicited by electrical stimulation and caused complete relaxation of contractions elicited by K+ with comparable IC50 values. Minoxidil sulphate was much less potent and diazoxide was without effect in either protocol. The relaxant effects of these agents were antagonized by glibenclamide, tetraethylammonium and yohimbine in a manner which was not surmountable. The present study indicates that the relaxant effect of these compounds in intestinal smooth muscle is mediated through glibenclamide-sensitive ATP-dependent K+ channels. These compounds did not preferentially inhibit either direct smooth muscle- or nerve-mediated responses. The present data may point to differences in the channels or their regulatory sites, in intestinal, compared with vascular, smooth muscle.
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Affiliation(s)
- M P Davies
- Postgraduate Studies in Pharmacology, School of Pharmacy, University of Bradford, West Yorkshire, UK
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Abstract
The physiological role of K+ channel opening by endogenous substances (e.g., neurotransmitters and hormones) is a recognised inhibitory mechanism. Thus, the identification of novel synthetic molecules that 'directly' open K+ channels has led to a new direction in the pharmacology of ion channels. The existence of many different subtypes of K+ channels has been an impetus in the search for new molecules demonstrating channel and, thus, tissue selectivity. This review focuses on the different classes of openers of K+ channels, the intracellular mechanisms involved in the execution of their effects, and potential therapeutic targets.
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Affiliation(s)
- K Lawson
- Division of Biomedical Sciences, School of Science, Sheffield Hallam University, UK
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Zhou Q, Satake N, Shibata S. The inhibitory mechanisms of nicorandil in isolated rat urinary bladder and femoral artery. Eur J Pharmacol 1995; 273:153-9. [PMID: 7737309 DOI: 10.1016/0014-2999(94)00685-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nicorandil or cromakalim inhibited contractile responses to acetylcholine and KCl in detrusor muscles of rat urinary bladder, whereas nitroglycerin inhibited only the responses to acetylcholine. In the detrusor muscles contracted by electrical stimulations, relaxations caused by nicorandil and cromakalim were inhibited by glyburide, but not by nitroglycerin or apamin. Methylene blue slightly potentiated the nicorandil-relaxation without affecting the cromakalim-relaxation. NG-Monomethyl-L-arginine also did not affect the relaxation induced by nicorandil. The level of cGMP was increased by both nicorandil and nitroglycerin. In rat femoral arteries contracted by phenylephrine, the relaxation induced by nicorandil was inhibited by methylene blue, glyburide and apamin. The relaxation induced by cromakalim was inhibited by glyburide, but not by apamin or methylene blue. These results suggest that the effect of nicorandil is due to activation of KATP channels in rat detrusor muscles and is due to the activation of guanylate cyclase, KATP and KCa channels in rat femoral arteries. The effect of cromakalim is due to the activation of KATP channels in both smooth muscles.
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Affiliation(s)
- Q Zhou
- Department of Pharmacology, University of Hawaii, School of Medicine, Honolulu 96822, USA
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Hieble JP, McCafferty GP, Naselsky DP, Bergsma DJ, Ruffolo RR. RECENT PROGRESS IN THE PHARMACOTHERAPY OF DISEASES OF THE LOWER URINARY TRACT. Eur J Med Chem 1995. [DOI: 10.1016/s0223-5234(23)00130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Affiliation(s)
- K S Atwal
- Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, New Jersey 08543-4000
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Abstract
Opening of K+ channels in cell membranes with resulting increase in K+ conductance, shifts the membrane potential in a hyperpolarizing direction towards the K+ equilibrium potential. Hyperpolarization reduces the opening probability of ion channels involved in membrane depolarization and excitation is reduced. K+ channel openers are believed to hyperpolarize smooth muscle cells by a direct action on the cell membrane. The best known members of the group are cromakalim, nicorandil and pinacidil, but several new compounds are being evaluated. In addition, it has recently been shown that also clinically well-known drugs like, e.g. diazoxide and minoxidil exhibit K+ channel opening properties. Nicorandil and new compounds containing nitro groups have a dual mechanism of action, also activating guanylate cyclase, an effect that contributes to their cardiovascular effect profile. K+ channel openers have a wide range of effects. Some of their properties and actions are summarized, and their present applications and/or potential for future application, in e.g. hypertension, angina pectoris, asthma, bladder instability, and several other disorders are discussed. It is concluded that K+ channel openning represents an interesting pharmacological principle with many potential clinical applications. However, most available drugs do not seem to have a sufficient tissue selectivity to be useful therapeutic alternatives. Before the potential of the new members of the group on clinical trials can be properly evaluated, clinical experiences are needed.
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Affiliation(s)
- K E Andersson
- Department of Clinical Pharmacology, Lund University Hospital, Sweden
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Longman SD, Hamilton TC. Potassium channel activator drugs: mechanism of action, pharmacological properties, and therapeutic potential. Med Res Rev 1992; 12:73-148. [PMID: 1535674 DOI: 10.1002/med.2610120202] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S D Longman
- SmithKline Beecham Pharmaceuticals, Medicinal Research Centre, Harlow, Essex, United Kingdom
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Hedlund H, Mattiasson A, Andersson KE. Effects of pinacidil on detrusor instability in men with bladder outlet obstruction. J Urol 1991; 146:1345-7. [PMID: 1942288 DOI: 10.1016/s0022-5347(17)38087-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a double-blind, crossover study the effect of the potassium channel opener pinacidil (N''-cyano-N'4-pyridyl-N-1,2,2-trimethylpropylguanidine monohydrate) at 25 mg. per day was evaluated in 10 patients with detrusor instability and bladder outlet obstruction. Nine patients completed the study: in 7 pinacidil was without significant effect on urodynamic variables and in 2 detrusor instability was not found at the end of the pinacidil period. Maximum urinary flow, frequency and nocturia were unchanged during pinacidil treatment, compared to the initial test and the placebo period. There was a significant decrease in standing blood pressure but heart rate was stable throughout the study. No patient experienced distinct symptomatic improvement or side effects during pinacidil treatment. The results suggest that pinacidil at the dosage given is not effective for treatment of unstable detrusor contractions associated with bladder outflow obstruction.
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Affiliation(s)
- H Hedlund
- Department of Urology, University Hospital, Lund, Sweden
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Mellemkjaer S, Nielsen-Kudsk JE, Nielsen CB, Siggaard C. A comparison of the relaxant effects of pinacidil in guinea-pig trachea, aorta and pulmonary artery. Eur J Pharmacol 1989; 167:275-80. [PMID: 2591478 DOI: 10.1016/0014-2999(89)90588-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The relaxant activity of pinacidil, a proposed K+ channel opener, was compared in isolated guinea-pig trachea, aorta and pulmonary artery. In preparations precontracted by histamine or PGF2 alpha, pinacidil produced complete tracheal relaxation but only partial relaxation of vascular tissues. The order of responsiveness was: pulmonary artery greater than trachea greater than aorta. The slope of the pinacidil concentration-effect (C/E) curve was much steeper in the tracheal than in the vascular preparations. The pinacidil C/E curves for relaxation were similar when the three types of preparations were precontracted by 124 mM K+. Pretreatment with pinacidil caused a parallel shift of the tracheal histamine C/E curve to the right, whereas the maximal response to histamine was markedly depressed in the pulmonary artery.
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Affiliation(s)
- S Mellemkjaer
- Institute of Pharmacology, University of Aarhus, Denmark
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Chapter 10. Potassium Channel Openers: New Biological Probes. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 1989. [DOI: 10.1016/s0065-7743(08)60532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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