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Rosenkranz S, Feldman J, McLaughlin VV, Rischard F, Lange TJ, White RJ, Peacock AJ, Gerhardt F, Ebrahimi R, Brooks G, Satler C, Frantz RP. Selonsertib in adults with pulmonary arterial hypertension (ARROW): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Respir Med 2021; 10:35-46. [PMID: 34425071 DOI: 10.1016/s2213-2600(21)00032-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data obtained in human lung tissue and preclinical models suggest that oxidative stress and increased apoptosis signal-regulating kinase 1 (ASK1) activity might have a prominent role in the pathobiology of pulmonary arterial hypertension (PAH). The purpose of this study was to determine the efficacy, safety, and tolerability of the ASK1 inhibitor selonsertib compared with placebo in patients with PAH. METHODS We did a randomised, double-blind, placebo-controlled, phase 2 trial at 46 centres located in Canada, France, Germany, Italy, the Netherlands, Spain, the UK, and the USA. Participants were aged 18-75 years and had an established diagnosis of idiopathic or hereditary PAH, or PAH associated with connective tissue disease, drugs or toxins, human immunodeficiency virus, or repaired congenital heart defects. Patients were stratified by PAH aetiology and background therapy, and randomly assigned (1:1:1:1) using an interactive voice-response or web-response system to placebo or selonsertib 2 mg, 6 mg, or 18 mg administered orally once daily. Both placebo and selonsertib were in tablet form. The primary efficacy endpoint was change in pulmonary vascular resistance, measured by right heart catheterisation, from baseline to week 24 in the full analysis set. Pair-wise comparisons between each of the selonsertib groups and the placebo group were made with a stratified Wilcoxon (van Elteren) rank sum test for participants without major protocol deviations who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT02234141. FINDINGS Between Dec 3, 2014, and Nov 13, 2015, 151 patients were enrolled and randomly assigned. Of 150 participants who received selonsertib or placebo, 134 (89%) completed 24 weeks of the randomly assigned treatment; all were on background PAH therapy (138 [92%] on combination therapy). 90 (60%) patients were in functional class II and 60 (40%) in functional class III. Mean baseline pulmonary vascular resistance was 772 (SD 334) dyn·s/cm5. Change in pulmonary vascular resistance was 6·0 dyn·s/cm5 (SD 28·0; n=31) for placebo, and 35·0 (35·4) dyn·s/cm5 (n=35; p=0·21 vs placebo) for 2 mg selonsertib, -28·0 (30·2) dyn·s/cm5 (n=34; p=0·27 vs placebo) for 6 mg selonsertib, and -21·0 (37·9) dyn·s/cm5 (n=36; p=0·60 vs placebo) for 18 mg selonsertib. The most frequent adverse events were headache (17 [15%]), abnormal dreams (eight [7%]), nausea (seven [6%]), and diarrhoea (seven [6%]) in the selonsertib groups, and headache (six [16%]), nausea (five [14%]), and diarrhoea (two [5%]) in the placebo group. Serious adverse events occurred in 23 (20%) of 113 selonsertib-treated patients and seven (19%) of 37 patients who received placebo. INTERPRETATION Selonsertib once daily for 24 weeks did not lead to a significant reduction in pulmonary vascular resistance or to clinical improvement in patients with PAH, but appeared to be safe and well tolerated. Although these data do not support the clinical use of selonsertib in PAH, further study of the potential of targeting the ASK1-p38 pathway in PAH is warranted. FUNDING Gilead Sciences.
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Affiliation(s)
- Stephan Rosenkranz
- Department of Cardiology, Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center, University of Cologne, Germany.
| | | | - Vallerie V McLaughlin
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Tobias J Lange
- Dept of Internal Medicine II, Pulmonology, University Medical Center Regensburg, Germany
| | - R James White
- University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Regional Heart & Lung Centre, Glasgow, UK
| | - Felix Gerhardt
- Department of Cardiology, Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center, University of Cologne, Germany
| | | | | | | | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Grünig E, MacKenzie A, Peacock AJ, Eichstaedt CA, Benjamin N, Nechwatal R, Ulrich S, Saxer S, Bussotti M, Sommaruga M, Ghio S, Gumbiene L, Palevičiūtė E, Jurevičienė E, Cittadini A, Stanziola AA, Marra AM, Kovacs G, Olschewski H, Barberà JA, Blanco I, Spruit MA, Franssen FME, Vonk Noordegraaf A, Reis A, Santos M, Viamonte SG, Demeyer H, Delcroix M, Bossone E, Johnson M. Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial. Eur Heart J 2021; 42:2284-2295. [PMID: 33232470 DOI: 10.1093/eurheartj/ehaa696] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS AND RESULTS For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group. CONCLUSION This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.
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Affiliation(s)
- Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany
| | - Alison MacKenzie
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Christina A Eichstaedt
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany.,Laboratory for Molecular Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany
| | | | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Clinic of Pulmonology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Maurizio Bussotti
- Cardiac Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, Milan, Italy
| | - Marinella Sommaruga
- Cardiac Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, Milan, Italy
| | - Stefano Ghio
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Lina Gumbiene
- Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Eglė Palevičiūtė
- Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Elena Jurevičienė
- Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Antonio Cittadini
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Anna A Stanziola
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Alberto M Marra
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany.,Department of Cardiovascular Imaging, IRCCS S.D.N., Naples, Italy
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Joan-Albert Barberà
- Department of Pulmonary Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona and Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona and Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Spain
| | - Martijn A Spruit
- Research and Development, Ciro, Horn, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Anton Vonk Noordegraaf
- Department of Pulmonology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Abílio Reis
- Department of Internal Medicine, Hospital Geral de Santo António, Porto, Portugal
| | - Mário Santos
- Department of Internal Medicine, Hospital Geral de Santo António, Porto, Portugal
| | | | - Heleen Demeyer
- Department of Pneumology, University Hospital Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospital Leuven, Leuven, Belgium
| | - Eduardo Bossone
- Department of Cardiology, Antonio Carderelli Hospital, Naples, Italy
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Hoeper MM, Al-Hiti H, Benza RL, Chang SA, Corris PA, Gibbs JSR, Grünig E, Jansa P, Klinger JR, Langleben D, McLaughlin VV, Meyer GMB, Ota-Arakaki J, Peacock AJ, Pulido T, Rosenkranz S, Vizza CD, Vonk-Noordegraaf A, White RJ, Chang M, Kleinjung F, Meier C, Paraschin K, Ghofrani HA, Simonneau G. Switching to riociguat versus maintenance therapy with phosphodiesterase-5 inhibitors in patients with pulmonary arterial hypertension (REPLACE): a multicentre, open-label, randomised controlled trial. Lancet Respir Med 2021; 9:573-584. [PMID: 33773120 DOI: 10.1016/s2213-2600(20)30532-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Riociguat and phosphodiesterase-5 inhibitors (PDE5i), approved for the treatment of pulmonary arterial hypertension (PAH), act on the same pathway via different mechanisms. Riociguat might be an alternative option for patients with PAH who do not respond sufficiently to treatment with PDE5i, but comparisons of the potential benefits of riociguat and PDE5i in these patients are needed. The aim of this trial was to assess the effects of switching to riociguat from PDE5i therapy versus continued PDE5i therapy in patients with PAH at intermediate risk of 1-year mortality. METHODS Riociguat rEplacing PDE5i therapy evaLuated Against Continued PDE5i thErapy (REPLACE) was an open-label, randomised controlled trial in 81 hospital-based pulmonary hypertension centres in 22 countries. The study enrolled patients aged 18-75 years with symptomatic PAH at intermediate risk of 1-year mortality (based on the European Society for Cardiology-European Respiratory Society guideline thresholds for WHO functional class and 6-min walk distance [6MWD]) who were receiving treatment with a PDE5i with or without an endothelin receptor antagonist for at least 6 weeks before randomisation. Patients were excluded if they had been previously treated with riociguat, had used prostacyclin analogues or prostacyclin receptor agonists within 30 days before randomisation, had clinically significant restrictive or obstructive parenchymal lung disease, or had left heart disease. Patients were randomly assigned (1:1) to remain on PDE5i treatment (oral sildenafil [≥60 mg per day] or oral tadalafil [20-40 mg per day]; the PDE5i group) or to switch to oral riociguat (up to 2·5 mg three times per day; the riociguat group), using an interactive voice and web response system, stratified by cause of PAH. The primary endpoint was clinical improvement by week 24, defined as an absence of clinical worsening and prespecified improvements in at least two of three variables (6MWD, WHO functional class, and N-terminal prohormone of brain natriuretic peptide), analysed using last observation carried forward in all randomly assigned patients with observed values at baseline and week 24 who received at least one dose of study medication (the full analysis set). Secondary endpoints included clinical worsening events. The trial has been completed and is registered with ClinicalTrials.gov, NCT02891850. FINDINGS Between Jan 11, 2017, and July 31, 2019, 293 patients were screened, of which 226 patients were randomly assigned to the riociguat group (n=111) or to the PDE5i group (n=115). 211 patients completed the study and 14 patients discontinued (seven in each group). One patient assigned to the PDE5i group did not receive treatment, so 225 patients were included in the safety analysis, and one further patient in the PDE5i group had missing components of the composite primary endpoint at baseline, so 224 patients were included in the full analysis set. The primary endpoint was met by 45 (41%) of 111 patients in the riociguat group and 23 (20%) of 113 patients in the PDE5i group; odds ratio [OR] 2·78 (95% CI 1·53-5·06; p=0·0007). Clinical worsening events occurred in one (1%) of 111 patients in the riociguat group (hospitalisation due to worsening PAH) and 10 (9%) of 114 patients in the PDE5i group (hospitalisation due to worsening PAH [n=9]; disease progression [n=1]; OR 0·10 [0·01-0·73]; p=0·0047). The most frequently occurring adverse events were hypotension (15 [14%]), headache (14 [13%]), and dyspepsia (10 [9%]) in the riociguat group, and headache (eight [7%]), cough (seven [6%]), and upper respiratory tract infection (seven [6%]) in the PDE5i group. Serious adverse events were reported in eight (7%) of 111 patients in the riociguat group and 19 (17%) of 114 patients in the PDE5i group. During the study, four patients died in the PDE5i group, one of them during the safety follow-up period. INTERPRETATION Switching to riociguat from PDE5i treatment, both of which act via the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate pathway, could be a strategic option for treatment escalation in patients with PAH at intermediate risk of 1-year mortality. FUNDING Bayer AG, Merck Sharp & Dohme.
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Affiliation(s)
- Marius M Hoeper
- Clinic for Respiratory Medicine, Hannover Medical School, member of the German Center for Lung Research (DZL), Hannover, Germany.
| | - Hikmet Al-Hiti
- Department of Cardiology, Institute of Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Raymond L Benza
- Division of Cardiovascular Diseases, Ohio State University, Columbus, OH, USA
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular and Stroke Institute Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, and Department of Cardiology, National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Center (TLRC), member of DZL, Heidelberg, Germany
| | - Pavel Jansa
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - James R Klinger
- Division of Pulmonary, Sleep, and Critical Care Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - David Langleben
- Center for Pulmonary Vascular Disease and Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Vallerie V McLaughlin
- Division of Cardiovascular Medicine, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Gisela M B Meyer
- Centro de Hipertensão Pulmonar, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Jaquelina Ota-Arakaki
- Pulmonary Circulation Group, Department of Medicine, Universidade Federal de São Paulo-Hospital São Paulo, São Paulo, Brazil
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Regional Lung and Heart Centre, Glasgow, UK
| | - Tomás Pulido
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology), Cologne Cardiovascular Research Center (CCRC), and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Carmine Dario Vizza
- Pulmonary Hypertension Unit, Department of Cardiovascular and Respiratory Disease, La Sapienza University of Rome, Rome, Italy
| | | | - R James White
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | - Hossein Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, member of DZL, Giessen, Germany; Department of Pneumology, Kerchoff Clinic, Bad Nauheim, Germany; Department of Medicine, Imperial College London, London, UK
| | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Saclay, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, and Inserm U999, Le Kremlin-Bicêtre, France
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4
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Lewis RA, Armstrong I, Bergbaum C, Brewis MJ, Cannon J, Charalampopoulos A, Church AC, Coghlan JG, Davies RJ, Dimopoulos K, Elliot C, Gibbs JSR, Gin-Sing W, Haji G, Hameed AG, Howard LS, Johnson MK, Kempny A, Kiely DG, Lo Giudice F, McCabe C, Peacock AJ, Peleyeju O, Pepke-Zaba J, Polwarth G, Price L, Sabroe I, Schreiber BE, Sheares K, Taboada D, Thompson AAR, Toshner MR, Wanjiku I, Wort SJ, Yorke J, Condliffe R. EmPHasis-10 health-related quality of life score predicts outcomes in patients with idiopathic and connective tissue disease-associated pulmonary arterial hypertension: results from a UK multicentre study. Eur Respir J 2021; 57:13993003.00124-2020. [PMID: 32631835 PMCID: PMC7905834 DOI: 10.1183/13993003.00124-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
Health-related quality of life (HRQoL) scores assess symptom burden in pulmonary arterial hypertension (PAH) but data regarding their role in prognostication and risk stratification are limited. We assessed these relationships using the emPHasis-10 HRQoL measure.1745 patients with idiopathic PAH (IPAH), drug-induced PAH (DPAH), heritable PAH (HPAH) (collectively "(I/D/H)PAH"), or connective tissue disease-associated PAH (CTD-PAH), who had completed emPHasis-10 questionnaires at one of six UK referral centres between 2014 and 2017, were identified. Correlations with exercise capacity and World Health Organization (WHO) functional class were assessed, and exploratory risk stratification thresholds were tested.Moderate correlations were seen between emPHasis-10 scores and 6-min walk distance (r=-0.546), incremental shuttle walk distance (r=-0.504) and WHO functional class (r=0.497) (all p<0.0001). Distribution of emPHasis-10 score differed significantly between each WHO functional class (all p<0.0001). On multivariate analysis, emPHasis-10 score, but not WHO functional class, was an independent predictor of mortality. In a risk stratification approach, scores of 0-16, 17-33 and 34-50 identified incident patients with 1-year mortality of 5%, 10% and 23%, respectively. Survival of patients in WHO functional class III could be further stratified using an emPHasis-10 score ≥34 (p<0.01). At follow-up, patients with improved emPHasis-10 scores had improved exercise capacity (p<0.0001) and patients who transitioned between risk groups demonstrated similar survival to patients originally in those risk groups.The emPHasis-10 score is an independent prognostic marker in patients with (I/D/H)PAH or CTD-PAH. It has utility in risk stratification in addition to currently used parameters. Improvement in emPHasis-10 score is associated with improved exercise capacity.
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Affiliation(s)
- Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Carmel Bergbaum
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - John Cannon
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - A Colin Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - J Gerry Coghlan
- Pulmonary Hypertension Unit, Royal Free Hospital, London, UK
| | - Rachel J Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Charlie Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - J Simon R Gibbs
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Wendy Gin-Sing
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Gulam Haji
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Abdul G Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Gary Polwarth
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Laura Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Ian Sabroe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Karen Sheares
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Dolores Taboada
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - A A Roger Thompson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mark R Toshner
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Ivy Wanjiku
- Pulmonary Hypertension Unit, Royal Free Hospital, London, UK
| | - S John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
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5
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Wilson KS, Buist H, Suveizdyte K, Liles JT, Budas GR, Hughes C, MacLean MR, Johnson M, Church AC, Peacock AJ, Welsh DJ. Apoptosis signal-regulating kinase 1 inhibition in in vivo and in vitro models of pulmonary hypertension. Pulm Circ 2020; 10:2045894020922810. [PMID: 32523684 PMCID: PMC7235684 DOI: 10.1177/2045894020922810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
Pulmonary arterial hypertension, group 1 of the pulmonary hypertension disease family, involves pulmonary vascular remodelling, right ventricular dysfunction and cardiac failure. Oxidative stress, through activation of mitogen-activated protein kinases is implicated in these changes. Inhibition of apoptosis signal-regulating kinase 1, an apical mitogen-activated protein kinase, prevented pulmonary arterial hypertension developing in rodent models. Here, we investigate apoptosis signal-regulating kinase 1 in pulmonary arterial hypertension by examining the impact that its inhibition has on the molecular and cellular signalling in established disease. Apoptosis signal-regulating kinase 1 inhibition was investigated in in vivo pulmonary arterial hypertension and in vitro pulmonary hypertension models. In the in vivo model, male Sprague Dawley rats received a single subcutaneous injection of Sugen SU5416 (20 mg/kg) prior to two weeks of hypobaric hypoxia (380 mmHg) followed by three weeks normoxia (Sugen/hypoxic), then animals were either maintained for three weeks on control chow or one containing apoptosis signal-regulating kinase 1 inhibitor (100 mg/kg/day). Cardiovascular measurements were carried out. In the in vitro model, primary cultures of rat pulmonary artery fibroblasts and rat pulmonary artery smooth muscle cells were maintained in hypoxia (5% O2) and investigated for proliferation, migration and molecular signalling in the presence or absence of apoptosis signal-regulating kinase 1 inhibitor. Sugen/hypoxic animals displayed significant pulmonary arterial hypertension compared to normoxic controls at eight weeks. Apoptosis signal-regulating kinase 1 inhibitor decreased right ventricular systolic pressure to control levels and reduced muscularised vessels in lung tissue. Apoptosis signal-regulating kinase 1 inhibition was found to prevent hypoxia-induced proliferation, migration and cytokine release in rat pulmonary artery fibroblasts and also prevented rat pulmonary artery fibroblast-induced rat pulmonary artery smooth muscle cell migration and proliferation. Apoptosis signal-regulating kinase 1 inhibition reversed pulmonary arterial hypertension in the Sugen/hypoxic rat model. These effects may be a result of intrinsic changes in the signalling of adventitial fibroblast.
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Affiliation(s)
- Kathryn S Wilson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Hanna Buist
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kornelija Suveizdyte
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Colin Hughes
- Central Research Facility, University of Glasgow, Glasgow, UK
| | - Margaret R MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UK
| | - David J Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Biological and Biomedical Science, Glasgow Caledonian University, Glasgow, UK
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6
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Peacock AJ, Ling Y, Johnson MK, Kiely DG, Condliffe R, Elliot CA, Gibbs JSR, Howard LS, Pepke-Zaba J, Sheares KKK, Corris PA, Fisher AJ, Lordan JL, Gaine S, Coghlan JG, Wort SJ, Gatzoulis MA. Idiopathic pulmonary arterial hypertension and co-existing lung disease: is this a new phenotype? Pulm Circ 2020; 10:2045894020914851. [PMID: 32284847 PMCID: PMC7132795 DOI: 10.1177/2045894020914851] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/23/2020] [Indexed: 11/26/2022] Open
Abstract
Patients classified as idiopathic pulmonary arterial hypertension (defined as Group 1 on European Respiratory Society (ERS)/European Cardiac Society (ESC) criteria) may have evidence of minor co-existing lung disease on thoracic computed tomography. We hypothesised that these idiopathic pulmonary arterial hypertension patients (IPAH lung disease) are a separate subgroup of idiopathic pulmonary arterial hypertension with different phenotype and outcome compared with idiopathic pulmonary arterial hypertension patients without co-existing lung disease (IPAH no lung disease). Patients with ‘IPAH lung disease’ have been eligible for all clinical trials of Group 1 patients because they have normal clinical examination and normal spirometry but we wondered whether they responded to treatment and had similar survival to patients with ‘IPAH no lung disease’. We described the outcome of the cohort of patients with ‘IPAH no lung disease’ in a previous paper. Here, we have compared incident ‘IPAH lung disease’ patients with ‘IPAH no lung disease’ patients diagnosed concurrently in all eight Pulmonary Hypertension centres in the UK and Ireland between 2001–2009. Compared with ‘IPAH no lung disease’ (n = 355), ‘IPAH lung disease’ patients (n = 137) were older, less obese, predominantly male, more likely to be current/ex-smokers and had lower six-minute walk distance, lower % predicted diffusion capacity for carbon monoxide, lower mean pulmonary arterial pressure and lower pulmonary vascular resistance index. After three months of pulmonary hypertension-targeted treatment, six-minute walk distance improved equally in ‘IPAH lung disease’ and ‘IPAH no lung disease’. However, survival of ‘IPAH lung disease’ was lower than ‘IPAH no lung disease’ (one year survival: 72% compared with 93%). This survival was significantly worse in ‘IPAH lung disease’ even after adjusting for age, gender, smoking history, comorbidities and haemodynamics. ‘IPAH lung disease’ patients had similar short-term improvement in six-minute walk distance with anti-pulmonary arterial hypertension therapy but worse survival compared with ‘IPAH no lung disease’ patients. This suggests that ‘IPAH lung disease’ are a separate phenotype and should not be lumped with ‘IPAH no lung disease’ in clinical trials of Group 1 pulmonary arterial hypertension.
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Affiliation(s)
- Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Yi Ling
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London and Hammersmith Hospital, London, UK
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London and Hammersmith Hospital, London, UK
| | | | | | - Paul A Corris
- Northern Pulmonary Vascular Unit, Freeman Hospital, Newcastle, UK
| | - Andrew J Fisher
- Northern Pulmonary Vascular Unit, Freeman Hospital, Newcastle, UK
| | - James L Lordan
- Northern Pulmonary Vascular Unit, Freeman Hospital, Newcastle, UK
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Gerry Coghlan
- Pulmonary Hypertension Unit, Royal Free Hospital, London, UK
| | - S John Wort
- Royal Brompton Pulmonary Hypertension and Adult Congenital Heart Centre, London, UK
| | - Michael A Gatzoulis
- Royal Brompton Pulmonary Hypertension and Adult Congenital Heart Centre, London, UK
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7
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Hodgson J, Swietlik EM, Salmon RM, Hadinnapola C, Nikolic I, Wharton J, Guo J, Liley J, Haimel M, Bleda M, Southgate L, Machado RD, Martin JM, Treacy CM, Yates K, Daugherty LC, Shamardina O, Whitehorn D, Holden S, Bogaard HJ, Church C, Coghlan G, Condliffe R, Corris PA, Danesino C, Eyries M, Gall H, Ghio S, Ghofrani HA, Gibbs JSR, Girerd B, Houweling AC, Howard L, Humbert M, Kiely DG, Kovacs G, Lawrie A, MacKenzie Ross RV, Moledina S, Montani D, Olschewski A, Olschewski H, Ouwehand WH, Peacock AJ, Pepke-Zaba J, Prokopenko I, Rhodes CJ, Scelsi L, Seeger W, Soubrier F, Suntharalingam J, Toshner MR, Trembath RC, Noordegraaf AV, Wort SJ, Wilkins MR, Yu PB, Li W, Gräf S, Upton PD, Morrell NW. Characterization of GDF2 Mutations and Levels of BMP9 and BMP10 in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2020; 201:575-585. [PMID: 31661308 PMCID: PMC7047445 DOI: 10.1164/rccm.201906-1141oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rationale: Recently, rare heterozygous mutations in GDF2 were identified in patients with pulmonary arterial hypertension (PAH). GDF2 encodes the circulating BMP (bone morphogenetic protein) type 9, which is a ligand for the BMP2 receptor.Objectives: Here we determined the functional impact of GDF2 mutations and characterized plasma BMP9 and BMP10 levels in patients with idiopathic PAH.Methods: Missense BMP9 mutant proteins were expressed in vitro and the impact on BMP9 protein processing and secretion, endothelial signaling, and functional activity was assessed. Plasma BMP9 and BMP10 levels and activity were assayed in patients with PAH with GDF2 variants and in control subjects. Levels were also measured in a larger cohort of control subjects (n = 120) and patients with idiopathic PAH (n = 260).Measurements and Main Results: We identified a novel rare variation at the GDF2 and BMP10 loci, including copy number variation. In vitro, BMP9 missense proteins demonstrated impaired cellular processing and secretion. Patients with PAH who carried these mutations exhibited reduced plasma levels of BMP9 and reduced BMP activity. Unexpectedly, plasma BMP10 levels were also markedly reduced in these individuals. Although overall BMP9 and BMP10 levels did not differ between patients with PAH and control subjects, BMP10 levels were lower in PAH females. A subset of patients with PAH had markedly reduced plasma levels of BMP9 and BMP10 in the absence of GDF2 mutations.Conclusions: Our findings demonstrate that GDF2 mutations result in BMP9 loss of function and are likely causal. These mutations lead to reduced circulating levels of both BMP9 and BMP10. These findings support therapeutic strategies to enhance BMP9 or BMP10 signaling in PAH.
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Affiliation(s)
| | - Emilia M. Swietlik
- Department of Medicine and,Royal Papworth Hospital, Papworth, United Kingdom
| | | | | | - Ivana Nikolic
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Matthias Haimel
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | | | - Laura Southgate
- Department of Medical and Molecular Genetics, King’s College London, London, United Kingdom,Molecular and Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Rajiv D. Machado
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Jennifer M. Martin
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Carmen M. Treacy
- Department of Medicine and,Royal Papworth Hospital, Papworth, United Kingdom
| | - Katherine Yates
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Louise C. Daugherty
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Olga Shamardina
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Deborah Whitehorn
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Simon Holden
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Harm J. Bogaard
- Département de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Cesare Danesino
- Department of Molecular Medicine, University of Pavia, Pavia, Italy,Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mélanie Eyries
- Département de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | - Henning Gall
- University of Giessen and Marburg Lung Center, member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute, Giessen, Germany
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hossein-Ardeschir Ghofrani
- Department of Medicine and,University of Giessen and Marburg Lung Center, member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute, Giessen, Germany
| | - J. Simon R. Gibbs
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara Girerd
- Faculté de Médecine, Université Paris-Saclay, Université Paris-Sud, Paris, France,Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France,Hôpital Bicêtre, Le Kremlin-Bicêtre, INSERM UMR_S 999, Paris, France
| | - Arjan C. Houweling
- Department of Clinical Genetics, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marc Humbert
- Faculté de Médecine, Université Paris-Saclay, Université Paris-Sud, Paris, France,Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France,Hôpital Bicêtre, Le Kremlin-Bicêtre, INSERM UMR_S 999, Paris, France
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,Medical University of Graz, Graz, Austria
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | | | - David Montani
- Faculté de Médecine, Université Paris-Saclay, Université Paris-Sud, Paris, France,Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France,Hôpital Bicêtre, Le Kremlin-Bicêtre, INSERM UMR_S 999, Paris, France
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,Medical University of Graz, Graz, Austria
| | - Willem H. Ouwehand
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | | | | | | | | | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Werner Seeger
- University of Giessen and Marburg Lung Center, member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute, Giessen, Germany
| | - Florent Soubrier
- Département de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | | | - Mark R. Toshner
- Department of Medicine and,Royal Papworth Hospital, Papworth, United Kingdom
| | - Richard C. Trembath
- Department of Medical and Molecular Genetics, King’s College London, London, United Kingdom
| | - Anton Vonk Noordegraaf
- Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Stephen J. Wort
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Royal Brompton Hospital, London, United Kingdom
| | | | - Paul B. Yu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wei Li
- Department of Medicine and
| | - Stefan Gräf
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | | | - Nicholas W. Morrell
- Department of Medicine and,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
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8
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Jayasekera G, Wilson KS, Buist H, Woodward R, Uckan A, Hughes C, Nilsen M, Church AC, Johnson MK, Gallagher L, Mullin J, MacLean MR, Holmes WM, Peacock AJ, Welsh DJ. Understanding longitudinal biventricular structural and functional changes in a pulmonary hypertension Sugen-hypoxia rat model by cardiac magnetic resonance imaging. Pulm Circ 2020; 10:2045894019897513. [PMID: 32095230 PMCID: PMC7011361 DOI: 10.1177/2045894019897513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/05/2019] [Indexed: 01/24/2023] Open
Abstract
Cardiac magnetic resonance-derived ventricular variables are predictive of mortality in pulmonary arterial hypertension. Rodent models which emphasize ventricular function, allowing serial monitoring, are needed to identify pathophysiological features and novel therapies for pulmonary arterial hypertension. We investigated longitudinal changes in the Sugen–hypoxia model during disease progression. Sprague Dawley rats (n = 32) were divided into two groups. (1) Sugen–hypoxia: a dose of subcutaneous Sugen-5416 and placed in hypobaric hypoxia for two weeks followed by normoxia for three weeks. (2) Normoxia: maintained at normal pressure for five weeks. Rats were examined at five or eight weeks with right-heart catheter, cardiac magnetic resonance, and autopsy. Compared to normoxic controls (23.9 ± 4.1 mmHg), right ventricular systolic pressure was elevated in Sugen–hypoxia rats at five and eight weeks (40.9 ± 15.5 mmHg, p = 0.026; 48.9 ± 9.6 mmHg, p = 0.002). Right ventricular end-systolic volume index was increased in eight weeks Sugen–hypoxia (0.28 ± 0.04 µlcm–2, p = 0.003) compared to normoxic controls (0.18 ±0.03 mlcm–2). There was progressive dilatation of the right ventricular at eight weeks Sugen–hypoxia compared to normoxic controls (0.75 ± 0.13 µlcm–2 vs 0.56 ± 0.1 µlcm–2p = 0.02). Ventricle mass index by cardiac magnetic resonance at five weeks (0.34 ± 0.06, p = 0.003) and eight weeks Sugen–hypoxia (0.34 ± 0.06, p = 0.002) were higher than normoxic controls (0.21 ± 0.04). Stroke volume, right ventricular ejection fraction, and left ventricular variables were preserved in Sugen–hypoxia. Ventricular changes during the course of illness in a pulmonary arterial hypertension rodent model can be examined by cardiac magnetic resonance. These changes including right ventricular hypertrophy and subsequent dilatation are similar to those seen in pulmonary arterial hypertension patients. Despite the persisting pulmonary hypertension, there are features of adaptive cardiac remodeling through the study duration.
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Affiliation(s)
| | - Kathryn S Wilson
- Scottish Pulmonary Vascular Unit, Glasgow Caledonian University, Glasgow, UK
| | - Hanna Buist
- Scottish Pulmonary Vascular Unit, Glasgow Caledonian University, Glasgow, UK
| | | | | | | | | | - A Colin Church
- Scottish Pulmonary Vascular Unit, Glasgow Caledonian University, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Glasgow Caledonian University, Glasgow, UK
| | | | | | | | | | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Glasgow Caledonian University, Glasgow, UK
| | - David J Welsh
- Scottish Pulmonary Vascular Unit, Glasgow Caledonian University, Glasgow, UK
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9
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Grünig E, Benjamin N, Eichstaedt CA, Peacock AJ. Multicentre trials on specialised exercise training and rehabilitation are useful in patients with pulmonary hypertension. Eur Respir J 2019; 54:54/5/1901631. [PMID: 31699780 DOI: 10.1183/13993003.01631-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik at the University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, Thoraxklinik at the University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christina A Eichstaedt
- Centre for Pulmonary Hypertension, Thoraxklinik at the University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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10
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Bohnen MS, Ma L, Zhu N, Qi H, McClenaghan C, Gonzaga-Jauregui C, Dewey FE, Overton JD, Reid JG, Shuldiner AR, Baras A, Sampson KJ, Bleda M, Hadinnapola C, Haimel M, Bogaard HJ, Church C, Coghlan G, Corris PA, Eyries M, Gibbs JSR, Girerd B, Houweling AC, Humbert M, Guignabert C, Kiely DG, Lawrie A, MacKenzie Ross RV, Martin JM, Montani D, Peacock AJ, Pepke-Zaba J, Soubrier F, Suntharalingam J, Toshner M, Treacy CM, Trembath RC, Vonk Noordegraaf A, Wharton J, Wilkins MR, Wort SJ, Yates K, Gräf S, Morrell NW, Krishnan U, Rosenzweig EB, Shen Y, Nichols CG, Kass RS, Chung WK. Loss-of-Function ABCC8 Mutations in Pulmonary Arterial Hypertension. Circ Genom Precis Med 2019; 11:e002087. [PMID: 30354297 DOI: 10.1161/circgen.118.002087] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In pulmonary arterial hypertension (PAH), pathological changes in pulmonary arterioles progressively raise pulmonary artery pressure and increase pulmonary vascular resistance, leading to right heart failure and high mortality rates. Recently, the first potassium channelopathy in PAH, because of mutations in KCNK3, was identified as a genetic cause and pharmacological target. METHODS Exome sequencing was performed to identify novel genes in a cohort of 99 pediatric and 134 adult-onset group I PAH patients. Novel rare variants in the gene identified were independently identified in a cohort of 680 adult-onset patients. Variants were expressed in COS cells and function assessed by patch-clamp and rubidium flux analysis. RESULTS We identified a de novo novel heterozygous predicted deleterious missense variant c.G2873A (p.R958H) in ABCC8 in a child with idiopathic PAH. We then evaluated all individuals in the original and a second cohort for rare or novel variants in ABCC8 and identified 11 additional heterozygous predicted damaging ABCC8 variants. ABCC8 encodes SUR1 (sulfonylurea receptor 1)-a regulatory subunit of the ATP-sensitive potassium channel. We observed loss of ATP-sensitive potassium channel function for all ABCC8 variants evaluated and pharmacological rescue of all channel currents in vitro by the SUR1 activator, diazoxide. CONCLUSIONS Novel and rare missense variants in ABCC8 are associated with PAH. Identified ABCC8 mutations decreased ATP-sensitive potassium channel function, which was pharmacologically recovered.
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Affiliation(s)
- Michael S Bohnen
- Department of Pharmacology, College of Physicians and Surgeons (M.S.B., K.J.S., R.S.K.), Columbia University, New York, NY
| | - Lijiang Ma
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
| | - Na Zhu
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY.,Department of Systems Biology (N.Z., H.Q., Y.S.), Columbia University, New York, NY
| | - Hongjian Qi
- Department of Applied Physics and Applied Mathematics (H.Q., Y.S.), Columbia University, New York, NY.,Department of Systems Biology (N.Z., H.Q., Y.S.), Columbia University, New York, NY
| | - Conor McClenaghan
- Department of Cell Biology and Physiology (C.M., C.G.N.) and Center for the Investigation of Membrane Excitability Diseases (C.M., C.G.N.), Washington University School of Medicine, Washington University in St. Louis, MO
| | - Claudia Gonzaga-Jauregui
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Frederick E Dewey
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - John D Overton
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Jeffrey G Reid
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Alan R Shuldiner
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Aris Baras
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Kevin J Sampson
- Department of Pharmacology, College of Physicians and Surgeons (M.S.B., K.J.S., R.S.K.), Columbia University, New York, NY
| | - Marta Bleda
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Charaka Hadinnapola
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Matthias Haimel
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Harm J Bogaard
- VU University Medical Center, Amsterdam, the Netherlands (H.J.B., A.C.H., A.V.N.)
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow, Scotland (C.C., A.J.P.)
| | | | - Paul A Corris
- Newcastle University (P.A.C.) and Newcastle upon Tyne Hospitals National Health Service Foundation Trust (P.A.C.), United Kingdom
| | - Mélanie Eyries
- Dépat de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (M.E., F.S.) and UMR_S 1166-ICAN, INSERM (Institut National de la Santé et de la Recherche Médicale) (M.E., F.S.), UPMC (Pierre and Marie Curie University) Sorbonne Universités, France
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, United Kingdom (J.S.R.G., S.J.W.)
| | - Barbara Girerd
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - Arjan C Houweling
- VU University Medical Center, Amsterdam, the Netherlands (H.J.B., A.C.H., A.V.N.)
| | - Marc Humbert
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - Christophe Guignabert
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - David G Kiely
- Sheffield Clinical Research Facility, Royal Hallamshire, Sheffield, United Kingdom (D.G.K.)
| | - Allan Lawrie
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom (A.L.)
| | | | - Jennifer M Martin
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - David Montani
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - Andrew J Peacock
- Golden Jubilee National Hospital, Glasgow, Scotland (C.C., A.J.P.)
| | | | - Florent Soubrier
- Dépat de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (M.E., F.S.) and UMR_S 1166-ICAN, INSERM (Institut National de la Santé et de la Recherche Médicale) (M.E., F.S.), UPMC (Pierre and Marie Curie University) Sorbonne Universités, France
| | | | - Mark Toshner
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom.,Papworth Hospital, Cambridge, United Kingdom (J.P.-Z., M.T.)
| | - Carmen M Treacy
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Richard C Trembath
- Division of Genetics and Molecular Medicine, King's College London, London, England (R.C.T.)
| | | | - John Wharton
- Department of Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom (J.W., M.R.W.)
| | - Martin R Wilkins
- Department of Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom (J.W., M.R.W.)
| | - Stephen J Wort
- National Heart and Lung Institute, Imperial College London, United Kingdom (J.S.R.G., S.J.W.).,Royal Brompton Hospital, London, United Kingdom (S.J.W.)
| | - Katherine Yates
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Stefan Gräf
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom.,Department of Hematology (S.G.), Addenbrookes Hospital, University of Cambridge, United Kingdom
| | - Nicholas W Morrell
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Usha Krishnan
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
| | - Erika B Rosenzweig
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
| | - Yufeng Shen
- Department of Applied Physics and Applied Mathematics (H.Q., Y.S.), Columbia University, New York, NY.,Department of Systems Biology (N.Z., H.Q., Y.S.), Columbia University, New York, NY
| | - Colin G Nichols
- Department of Cell Biology and Physiology (C.M., C.G.N.) and Center for the Investigation of Membrane Excitability Diseases (C.M., C.G.N.), Washington University School of Medicine, Washington University in St. Louis, MO
| | - Robert S Kass
- Department of Pharmacology, College of Physicians and Surgeons (M.S.B., K.J.S., R.S.K.), Columbia University, New York, NY
| | - Wendy K Chung
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
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11
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Sofianopoulou E, Kaptoge S, Gräf S, Hadinnapola C, Treacy CM, Church C, Coghlan G, Gibbs JSR, Haimel M, Howard LS, Johnson M, Kiely DG, Lawrie A, Lordan J, MacKenzie Ross RV, Martin JM, Moledina S, Newnham M, Peacock AJ, Price LC, Rhodes CJ, Suntharalingam J, Swietlik EM, Toshner MR, Wharton J, Wilkins MR, Wort SJ, Pepke-Zaba J, Condliffe R, Corris PA, Di Angelantonio E, Provencher S, Morrell NW. Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis. Eur Respir J 2019; 53:13993003.01429-2018. [PMID: 30923185 DOI: 10.1183/13993003.01429-2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/02/2019] [Indexed: 01/03/2023]
Abstract
While traffic and air pollution exposure is associated with increased mortality in numerous diseases, its association with disease severity and outcomes in pulmonary arterial hypertension (PAH) remains unknown.Exposure to particulate matter with a 50% cut-off aerodynamic diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and indirect measures of traffic-related air pollution (distance to main road and length of roads within buffer zones surrounding residential addresses) were estimated for 301 patients with idiopathic/heritable PAH recruited in the UK National Cohort Study of Idiopathic and Heritable PAH. Associations with transplant-free survival and pulmonary haemodynamic severity at baseline were assessed, adjusting for confounding variables defined a prioriHigher estimated exposure to PM2.5 was associated with higher risk of death or lung transplant (unadjusted hazard ratio (HR) 2.68 (95% CI 1.11-6.47) per 3 μg·m-3; p=0.028). This association remained similar when adjusted for potential confounding variables (HR 4.38 (95% CI 1.44-13.36) per 3 μg·m-3; p=0.009). No associations were found between NO2 exposure or other traffic pollution indicators and transplant-free survival. Conversely, indirect measures of exposure to traffic-related air pollution within the 500-1000 m buffer zones correlated with the European Society of Cardiology/European Respiratory Society risk categories as well as pulmonary haemodynamics at baseline. This association was strongest for pulmonary vascular resistance.In idiopathic/heritable PAH, indirect measures of exposure to traffic-related air pollution were associated with disease severity at baseline, whereas higher PM2.5 exposure may independently predict shorter transplant-free survival.
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Affiliation(s)
- Eleni Sofianopoulou
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK.,Joint supervision
| | - Stephen Kaptoge
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stefan Gräf
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | | | - Carmen M Treacy
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.,BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Matthias Haimel
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James Lordan
- NIHR Biomedical Research Centre in Ageing, University of Newcastle, Newcastle, UK
| | - Robert V MacKenzie Ross
- National Pulmonary Hypertension Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jennifer M Martin
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service, Great Ormond Street Hospital, London, UK
| | | | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Christopher J Rhodes
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Jay Suntharalingam
- National Pulmonary Hypertension Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Emilia M Swietlik
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Mark R Toshner
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - John Wharton
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Martin R Wilkins
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Stephen J Wort
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul A Corris
- NIHR Biomedical Research Centre in Ageing, University of Newcastle, Newcastle, UK
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,NHS Blood and Transplant, Cambridge, UK
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Nicholas W Morrell
- Dept of Medicine, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK.,Joint supervision
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12
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Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
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13
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Vachiéry JL, Galiè N, Barberá JA, Frost AE, Ghofrani HA, Hoeper MM, McLaughlin VV, Peacock AJ, Simonneau G, Blair C, Miller KL, Langley J, Rubin LJ. Initial combination therapy with ambrisentan + tadalafil on pulmonary arterial hypertension‒related hospitalization in the AMBITION trial. J Heart Lung Transplant 2019; 38:194-202. [DOI: 10.1016/j.healun.2018.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/17/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022] Open
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14
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Nathan SD, Barbera JA, Gaine SP, Harari S, Martinez FJ, Olschewski H, Olsson KM, Peacock AJ, Pepke-Zaba J, Provencher S, Weissmann N, Seeger W. Pulmonary hypertension in chronic lung disease and hypoxia. Eur Respir J 2019; 53:13993003.01914-2018. [PMID: 30545980 PMCID: PMC6351338 DOI: 10.1183/13993003.01914-2018] [Citation(s) in RCA: 342] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension (PH) frequently complicates the course of patients with various forms of chronic lung disease (CLD). CLD-associated PH (CLD-PH) is invariably associated with reduced functional ability, impaired quality of life, greater oxygen requirements and an increased risk of mortality. The aetiology of CLD-PH is complex and multifactorial, with differences in the pathogenic sequelae between the diverse forms of CLD. Haemodynamic evaluation of PH severity should be contextualised within the extent of the underlying lung disease, which is best gauged through a combination of physiological and imaging assessment. Who, when, if and how to screen for PH will be addressed in this article, as will the current state of knowledge with regard to the role of treatment with pulmonary vasoactive agents. Although such therapy cannot be endorsed given the current state of findings, future studies in this area are strongly encouraged. State of the art and research perspectives in pulmonary hypertension in chronic lung disease and hypoxiahttp://ow.ly/XcW730meWxy
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Affiliation(s)
| | - Joan A Barbera
- Dept of Pulmonary Medicine, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | - Sean P Gaine
- Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | | | - Horst Olschewski
- Division of Pulmonology, Medizinische Universitat Graz, Graz, Austria
| | - Karen M Olsson
- Dept of Respiratory Medicine, Hannover Medical School and Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Regional Lung and Heart Centre, Glasgow, UK
| | | | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Norbert Weissmann
- University of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University Giessen and Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Werner Seeger
- University of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University Giessen and Member of the German Center for Lung Research (DZL), Giessen, Germany
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15
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Grünig E, Eichstaedt C, Barberà JA, Benjamin N, Blanco I, Bossone E, Cittadini A, Coghlan G, Corris P, D'Alto M, D'Andrea A, Delcroix M, de Man F, Gaine S, Ghio S, Gibbs S, Gumbiene L, Howard LS, Johnson M, Jurevičienė E, Kiely DG, Kovacs G, MacKenzie A, Marra AM, McCaffrey N, McCaughey P, Naeije R, Olschewski H, Pepke-Zaba J, Reis A, Santos M, Saxer S, Tulloh RM, Ulrich S, Vonk Noordegraaf A, Peacock AJ. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J 2018; 53:13993003.00332-2018. [DOI: 10.1183/13993003.00332-2018] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 09/12/2018] [Indexed: 12/17/2022]
Abstract
Objectives of this European Respiratory Society task force were to summarise current studies, to develop strategies for future research and to increase availability and awareness of exercise training for pulmonary hypertension (PH) patients.An evidence-based approach with clinical expertise of the task force members, based on both literature search and face-to-face meetings was conducted. The statement summarises current knowledge and open questions regarding clinical effects of exercise training in PH, training modalities, implementation strategies and pathophysiological mechanisms.In studies (784 PH patients in total, including six randomised controlled trials, three controlled trials, 10 prospective cohort studies and four meta-analyses), exercise training has been shown to improve exercise capacity, muscular function, quality of life and possibly right ventricular function and pulmonary haemodynamics. Nevertheless, further studies are needed to confirm these data, to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.As exercise training appears to be effective, cost-efficient and safe, but is scarcely reimbursed, support from healthcare institutions, commissioners of healthcare and research funding institutions is greatly needed. There is a strong need to establish specialised rehabilitation programmes for PH patients to enhance patient access to this treatment intervention.
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16
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Martinez C, Wallenhorst C, Teal S, Cohen AT, Peacock AJ. Incidence and risk factors of chronic thromboembolic pulmonary hypertension following venous thromboembolism, a population-based cohort study in England. Pulm Circ 2018; 8:2045894018791358. [PMID: 29985100 PMCID: PMC6066824 DOI: 10.1177/2045894018791358] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of
unresolved organised pulmonary emboli/thrombi obstructing the major pulmonary
arteries. The aim of this study was to estimate the incidence and risk factors
of CTEPH in a cohort with first venous thromboembolism (VTE). This was a
population-based cohort study of patients with first VTE and no active cancer in
England between 2001 and 2012. CTEPH was assessed using a rigorous
case-ascertainment algorithm. Risk factors for CTEPH were studied using a nested
case-control approach by matching CTEPH cases to VTE patients without CTEPH.
Adjusted odds ratios (OR) of comorbidities were estimated from conditional
logistic regression. During 81,413 person-years of follow-up among 23,329
patients with first VTE (mean follow-up 3.5 years; maximum 11.0 years) 283
patients were diagnosed with CTEPH (incidence rate 3.5 per 1000 person-years);
cumulative incidence was 1.3% and 3.3% at 2 and 10 years after pulmonary
embolism, and 0.3% and 1.3% following deep vein thrombosis (DVT), respectively.
Risk factors for CTEPH included age over 70, OR 2.04 (95% CI 1.23 to 3.38),
female gender, 1.44 (1.06 to 1.94), pulmonary embolism at first VTE, 3.11 (2.23
to 4.35), subsequent pulmonary embolism and DVT, 3.17 (2.02 to 4.96) and 2.46
(1.34 to 4.51) respectively, chronic obstructive pulmonary disease 3.17 (2.13 to
4.73), heart failure 2.52 (1.76 to 3.63) and atrial fibrillation, 2.42 (1.71 to
3.42). CTEPH develops most commonly after pulmonary embolism and less frequently
after DVT. Awareness of risk factors may increase referrals to specialised
centres for confirmation of CTEPH and initiation of specific treatment.
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Affiliation(s)
- C Martinez
- 1 Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
| | - C Wallenhorst
- 1 Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
| | - S Teal
- 2 Real-World Evidence Strategy & Outcomes Data Generation, Bayer AG, Berlin, Germany
| | - A T Cohen
- 3 Department of Haematology, Guy's and St Thomas' Hospitals, King's College, London, UK
| | - A J Peacock
- 4 Scottish Pulmonary Vascular Unit, Regional Heart and Lung centre, Glasgow, UK
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17
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Gräf S, Haimel M, Bleda M, Hadinnapola C, Southgate L, Li W, Hodgson J, Liu B, Salmon RM, Southwood M, Machado RD, Martin JM, Treacy CM, Yates K, Daugherty LC, Shamardina O, Whitehorn D, Holden S, Aldred M, Bogaard HJ, Church C, Coghlan G, Condliffe R, Corris PA, Danesino C, Eyries M, Gall H, Ghio S, Ghofrani HA, Gibbs JSR, Girerd B, Houweling AC, Howard L, Humbert M, Kiely DG, Kovacs G, MacKenzie Ross RV, Moledina S, Montani D, Newnham M, Olschewski A, Olschewski H, Peacock AJ, Pepke-Zaba J, Prokopenko I, Rhodes CJ, Scelsi L, Seeger W, Soubrier F, Stein DF, Suntharalingam J, Swietlik EM, Toshner MR, van Heel DA, Vonk Noordegraaf A, Waisfisz Q, Wharton J, Wort SJ, Ouwehand WH, Soranzo N, Lawrie A, Upton PD, Wilkins MR, Trembath RC, Morrell NW. Identification of rare sequence variation underlying heritable pulmonary arterial hypertension. Nat Commun 2018; 9:1416. [PMID: 29650961 PMCID: PMC5897357 DOI: 10.1038/s41467-018-03672-4] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/02/2018] [Indexed: 12/20/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disorder with a poor prognosis. Deleterious variation within components of the transforming growth factor-β pathway, particularly the bone morphogenetic protein type 2 receptor (BMPR2), underlies most heritable forms of PAH. To identify the missing heritability we perform whole-genome sequencing in 1038 PAH index cases and 6385 PAH-negative control subjects. Case-control analyses reveal significant overrepresentation of rare variants in ATP13A3, AQP1 and SOX17, and provide independent validation of a critical role for GDF2 in PAH. We demonstrate familial segregation of mutations in SOX17 and AQP1 with PAH. Mutations in GDF2, encoding a BMPR2 ligand, lead to reduced secretion from transfected cells. In addition, we identify pathogenic mutations in the majority of previously reported PAH genes, and provide evidence for further putative genes. Taken together these findings contribute new insights into the molecular basis of PAH and indicate unexplored pathways for therapeutic intervention.
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Affiliation(s)
- Stefan Gräf
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom.
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom.
| | - Matthias Haimel
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Marta Bleda
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Charaka Hadinnapola
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Laura Southgate
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, SW17 0RE, United Kingdom
- Division of Genetics & Molecular Medicine, King's College London, London, WC2R 2LS, United Kingdom
| | - Wei Li
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Joshua Hodgson
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Bin Liu
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Richard M Salmon
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Mark Southwood
- Royal Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
| | - Rajiv D Machado
- Institute of Medical and Biomedical Education, St George's University of London, London, SW17 0RE, United Kingdom
| | - Jennifer M Martin
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Carmen M Treacy
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Royal Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
| | - Katherine Yates
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Louise C Daugherty
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Olga Shamardina
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Deborah Whitehorn
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Simon Holden
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | | | - Harm J Bogaard
- VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow, G81 4DY, United Kingdom
| | - Gerry Coghlan
- Royal Free Hospital, London, NW3 2QG, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom
| | - Paul A Corris
- University of Newcastle, Newcastle, NE1 7RU, United Kingdom
| | - Cesare Danesino
- Department of Molecular Medicine, University of Pavia, Pavia, 27100, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Mélanie Eyries
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, 75252, France
| | - Henning Gall
- University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary System (ECCCPS), Giessen, 35392, Germany
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary System (ECCCPS), Giessen, 35392, Germany
- Imperial College London, London, SW7 2AZ, United Kingdom
| | - J Simon R Gibbs
- National Heart & Lung Institute, Imperial College London, London, SW3 6LY, United Kingdom
| | - Barbara Girerd
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay; AP-HP, Service de Pneumologie, Centre de référence de l'hypertension pulmonaire; INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, 94270, France
| | | | - Luke Howard
- Imperial College London, London, SW7 2AZ, United Kingdom
| | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay; AP-HP, Service de Pneumologie, Centre de référence de l'hypertension pulmonaire; INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, 94270, France
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, 8010, Austria
- Medical University of Graz, Graz, 8036, Austria
| | | | - Shahin Moledina
- Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
| | - David Montani
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay; AP-HP, Service de Pneumologie, Centre de référence de l'hypertension pulmonaire; INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, 94270, France
| | - Michael Newnham
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, 8010, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, 8010, Austria
- Medical University of Graz, Graz, 8036, Austria
| | - Andrew J Peacock
- Golden Jubilee National Hospital, Glasgow, G81 4DY, United Kingdom
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
| | | | | | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Werner Seeger
- University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary System (ECCCPS), Giessen, 35392, Germany
| | - Florent Soubrier
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, 75252, France
| | - Dan F Stein
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Jay Suntharalingam
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, United Kingdom
| | - Emilia M Swietlik
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Mark R Toshner
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - David A van Heel
- Blizard Institute, Queen Mary University of London, London, E1 2AT, United Kingdom
| | | | - Quinten Waisfisz
- VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - John Wharton
- Imperial College London, London, SW7 2AZ, United Kingdom
| | - Stephen J Wort
- Imperial College London, London, SW7 2AZ, United Kingdom
- Royal Brompton Hospital, London, SW3 6NP, United Kingdom
| | - Willem H Ouwehand
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Nicole Soranzo
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, United Kingdom
| | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, United Kingdom
| | - Paul D Upton
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | | | - Richard C Trembath
- Division of Genetics & Molecular Medicine, King's College London, London, WC2R 2LS, United Kingdom
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom.
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18
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Brash L, Barnes GD, Brewis MJ, Church AC, Gibbs SJ, Howard LSGE, Jayasekera G, Johnson MK, McGlinchey N, Onorato J, Simpson J, Stirrat C, Thomson S, Watson G, Wilkins MR, Xu C, Welsh DJ, Newby DE, Peacock AJ. Short-Term Hemodynamic Effects of Apelin in Patients With Pulmonary Arterial Hypertension. JACC Basic Transl Sci 2018; 3:176-186. [PMID: 29876530 PMCID: PMC5981010 DOI: 10.1016/j.jacbts.2018.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/02/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
The effects of apelin on pulmonary hemodynamics in patients with PAH are unknown. Systemic infusion caused a significant reduction in pulmonary vascular resistance and increase in cardiac output without a change in heart rate or systemic vascular resistance. This effect was most prominent in the subgroup of patients receiving concomitant PDE5 inhibition. Apelin agonism is a novel potential therapeutic target for PAH.
Apelin agonism causes systemic vasodilatation and increased cardiac contractility in humans, and improves pulmonary arterial hypertension (PAH) in animal models. Here, the authors examined the short-term pulmonary hemodynamic effects of systemic apelin infusion in patients with PAH. In a double-blind randomized crossover study, 19 patients with PAH received intravenous (Pyr1)apelin-13 and matched saline placebo during invasive right heart catheterization. (Pyr1)apelin-13 infusion caused a reduction in pulmonary vascular resistance and increased cardiac output. This effect was accentuated in the subgroup of patients receiving concomitant phosphodiesterase type 5 inhibition. Apelin agonism is a novel potential therapeutic target for PAH. (Effects of Apelin on the Lung Circulation in Pulmonary Hypertension; NCT01457170)
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Affiliation(s)
- Lauren Brash
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Gareth D Barnes
- National Pulmonary Hypertension Service-London, Department of Cardiac Sciences, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Colin Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Simon J Gibbs
- National Pulmonary Hypertension Service-London, Department of Cardiac Sciences, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Luke S G E Howard
- National Pulmonary Hypertension Service-London, Department of Cardiac Sciences, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Geeshath Jayasekera
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Neil McGlinchey
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Joelle Onorato
- Bristol-Myers Squibb Company, Discovery R&D, Princeton, New Jersey
| | - Joanne Simpson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Colin Stirrat
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Thomson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Geoffrey Watson
- National Pulmonary Hypertension Service-London, Department of Cardiac Sciences, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Martin R Wilkins
- National Pulmonary Hypertension Service-London, Department of Cardiac Sciences, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Carrie Xu
- Bristol-Myers Squibb Company, Discovery R&D, Princeton, New Jersey
| | - David J Welsh
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - David E Newby
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
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19
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Pellino K, Kerridge S, Church C, Peacock AJ, Crowe T, Jayasekera G, Johnson MK, MacKenzie A. Social deprivation and prognosis in Scottish patients with pulmonary arterial hypertension. Eur Respir J 2018; 51:51/2/1700444. [DOI: 10.1183/13993003.00444-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/05/2017] [Indexed: 11/05/2022]
Abstract
Several demographic and clinical factors have prognostic significance in idiopathic pulmonary arterial hypertension (IPAH). Studies in China and the USA have suggested an association between low socioeconomic status and reduced survival. The impact of social deprivation on IPAH survival in the UK is not known.280 patients with IPAH and hereditary PAH (HPAH) attending the Scottish Pulmonary Vascular Unit (Glasgow, UK) were assigned to social deprivation quintiles using the Scottish Index of Multiple Deprivation database. The association between survival and social deprivation quintile was assessed using Cox proportional hazards regression analysis.The distribution of IPAH/HPAH patients was more socially deprived than would be expected based on Scottish citizenry as a whole (Chi-squared 16.16, p=0.003), suggesting referral and access to care is not impeded by socioeconomic status. Univariate analysis demonstrated no significant association between social deprivation and survival (p=0.81), and this association failed to reach significance with inclusion of time, sex and age as covariates in the model (p=0.23). There were no statistically significant correlations between social deprivation and baseline clinical variables of prognostic importance except for age, sex and quality of life.Social deprivation is not a significant referral barrier or prognostic factor for IPAH and HPAH in Scotland.
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Abstract
Pulmonary hypertension (PH) is a progressive illness characterized by elevated pulmonary artery pressure; however, the main cause of mortality in PH patients is right ventricular (RV) failure. Historically, improving the hemodynamics of pulmonary circulation was the focus of treatment; however, it is now evident that cardiac response to a given level of pulmonary hemodynamic overload is variable but plays an important role in the subsequent prognosis. Non-invasive tests of RV function to determine prognosis and response to treatment in patients with PH is essential. Although the right ventricle is the focus of attention, it is clear that cardiac interaction can cause left ventricular dysfunction, thus biventricular assessment is paramount. There is also focus on the atrial chambers in their contribution to cardiac function in PH. Furthermore, there is evidence of regional dysfunction of the two ventricles in PH, so it would be useful to understand both global and regional components of dysfunction. In order to understand global and regional cardiac function in PH, the most obvious non-invasive imaging techniques are echocardiography and cardiac magnetic resonance imaging (CMRI). Both techniques have their advantages and disadvantages. Echocardiography is widely available, relatively inexpensive, provides information regarding RV function, and can be used to estimate RV pressures. CMRI, although expensive and less accessible, is the gold standard of biventricular functional measurements. The advent of 3D echocardiography and techniques including strain analysis and stress echocardiography have improved the usefulness of echocardiography while new CMRI technology allows the measurement of strain and measuring cardiac function during stress including exercise. In this review, we have analyzed the advantages and disadvantages of the two techniques and discuss pre-existing and novel forms of analysis where echocardiography and CMRI can be used to examine atrial, ventricular, and interventricular function in patients with PH at rest and under stress.
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Affiliation(s)
- Tim Crowe
- 41444 Cardiac and Vascular Imaging Group, Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Geeshath Jayasekera
- 41444 Cardiac and Vascular Imaging Group, Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- 41444 Cardiac and Vascular Imaging Group, Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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21
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Bellofiore A, Vanderpool R, Brewis MJ, Peacock AJ, Chesler NC. A novel single-beat approach to assess right ventricular systolic function. J Appl Physiol (1985) 2017; 124:283-290. [PMID: 29025899 DOI: 10.1152/japplphysiol.00258.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Clinical assessment of right ventricular (RV) contractility in diseases such as pulmonary arterial hypertension (PAH) has been hindered by the lack of a robust methodology. Here, a novel, clinically viable, single-beat method was developed to assess end-systolic elastance (Ees), a measure of right ventricular (RV) contractility. We hypothesized that this novel approach reduces uncertainty and interobserver variability in the estimation of the maximum isovolumic pressure (Piso), the key step in single-beat methods. The new method was designed to include a larger portion of the RV pressure data and minimize subjective adjustments by the operator. Data were obtained from right heart catheterization of PAH patients in a multicenter prospective study ( data set 1) and a single-center retrospective study ( data set 2). To obtain Piso, three independent observers used an established single-beat method (based on the first derivative of the pressure waveform) and the novel method (based on the second derivative). Interobserver variability analysis included paired t-test, one-way ANOVA, interclass correlation (ICC) analysis, and a modified Bland-Altman analysis. The Piso values obtained from the two methods were linearly correlated for both data set 1 ( R2 = 0.74) and data set 2 ( R2 = 0.91). Compared with the established method, the novel method resulted in smaller interobserver variability ( P < 0.001), nonsignificant differences between observers, and a narrower confidence interval. By reducing uncertainty and interobserved variability, this novel approach may pave the way for more effective clinical management of PAH. NEW & NOTEWORTHY A novel methodology to assess right ventricular contractility from clinical data is demonstrated. This approach significantly reduces interobserver variability in the analysis of ventricular pressure data, as demonstrated in a relatively large population of subjects with pulmonary hypertension. This study may enable more accurate clinical monitoring of systolic function in subjects with pulmonary hypertension.
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Affiliation(s)
- Alessandro Bellofiore
- Department of Biomedical, Chemical and Materials Engineering, San Jose State University , San Jose, California.,Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin
| | - Rebecca Vanderpool
- Vascular Medicine Institute, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital , Glasgow , United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital , Glasgow , United Kingdom
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin.,Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin
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22
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Panagiotou M, Johnson MK, Louvaris Z, Baker JS, Church AC, Peacock AJ, Vogiatzis I. A study of clinical and physiological relations of daily physical activity in precapillary pulmonary hypertension. J Appl Physiol (1985) 2017; 123:851-859. [PMID: 28663381 DOI: 10.1152/japplphysiol.00986.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022] Open
Abstract
Daily physical activity is reduced in precapillary pulmonary hypertension (PH), but the underlying mechanisms are inadequately explored. We sought to investigate clinical and physiological relations of daily physical activity and profile differences between less and more active patients with precapillary PH. A prospective, cross-sectional study of 20 patients with precapillary PH who undertook 1) a comprehensive clinical assessment, 2) a preliminary treadmill test, 3) 7-day monitoring of daily walking intensity with triaxial accelerometry, and 4) a personalized treadmill test corresponding to the individual patient mean daily walking intensity with real-time physiological measurements. Significant clinical correlations with individual patient mean walking intensity [1.71 ± 0.27 (SD) m/s2] were observed for log-transformed N-terminal probrain natriuretic peptide (log NT-proBNP; r = -0.75, P = <.001), age (r = -0.70, P = 0.001), transfer factor for carbon monoxide %predicted (r = 0.51, P = 0.022), and 6-min walk distance (r = 0.50, P = 0.026). Significant physiological correlations were obtained for heart rate reserve (r = 0.68, P = 0.001), quadriceps tissue oxygenation index (Q-[Formula: see text]; r = 0.58, P = 0.008), change in Q-[Formula: see text] from rest (r = 0.60, P = 0.006), and ventilatory equivalent for oxygen uptake (r = -0.56, P = 0.013). Stepwise multiple regression analyses retained log NT-proBNP (R2 = 0.55), heart rate reserve (R2 = 0.44), and Q-[Formula: see text] (R2 = 0.13) accounting for a significant variance in individual walking intensity. Less active patients had greater physical activity-induced cardiopulmonary impairment, worse quadriceps oxygenation profile, and compromised health-related quality of life compared with more active patients. These preliminary findings suggest a significant relation between right ventricular and peripheral muscle oxygenation status and reduced daily physical activity in precapillary PH. Further research is warranted to unravel the physiological determinants, establish clinical predictors, and identify beneficial interventions.NEW & NOTEWORTHY Daily physical activity holds promise to be a meaningful, patient-related outcome measure in pulmonary hypertension. In this study, novel findings in a representative sample of patients with precapillary pulmonary hypertension link reduced daily walking activity, as measured by triaxial accelerometry, with compromised right ventricular and pulmonary vascular status, peripheral muscle oxygenation, and health-related quality of life, providing a preliminary insight into the physiological mechanisms and clinical predictors of daily physical activity in precapillary pulmonary hypertension.
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Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom;
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Zafeiris Louvaris
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece.,Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Division of Respiratory Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Julien S Baker
- Institute of Clinical Exercise and Health Sciences, University of the West of Scotland, Hamilton, United Kingdom; and
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Ioannis Vogiatzis
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece.,School of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
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23
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Peacock AJ. Measuring the effects of treatment in patients with PAH: should we image the right ventricle? Eur Respir J 2017; 49:49/6/1700805. [PMID: 28663319 DOI: 10.1183/13993003.00805-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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24
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Vachiéry JL, Hoeper MM, Peacock AJ, Sitbon O, Cheli M, Church C, Olsson KM, Palazzini M, Waterhouse B, Langley J, Galié N. Ambrisentan use for pulmonary arterial hypertension in a post-authorization drug registry: The VOLibris Tracking Study. J Heart Lung Transplant 2017; 36:399-406. [DOI: 10.1016/j.healun.2016.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022] Open
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25
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Blyth KG, Bellofiore A, Jayasekera G, Foster JE, Steedman T, Chesler NC, Peacock AJ. Dobutamine stress MRI in pulmonary hypertension: relationships between stress pulmonary artery relative area change, RV performance, and 10-year survival. Pulm Circ 2017; 7:465-475. [PMID: 28597775 PMCID: PMC5467938 DOI: 10.1177/2045893217704838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In pulmonary hypertension (PH), right ventricular (RV) performance determines survival. Pulmonary artery (PA) stiffening is an important biomechanical event in PH and also predicts survival based on the PA relative area change (RAC) measured at rest using magnetic resonance imaging (MRI). In this exploratory study, we sought to generate novel hypotheses regarding the influence of stress RAC on PH prognosis and the interaction between PA stiffening, RV performance and survival. Fifteen PH patients underwent dobutamine stress-MRI (ds-MRI) and right heart catheterization. RACREST, RACSTRESS, and ΔRAC (RAC STRESS - RAC REST) were correlated against resting invasive hemodynamics and ds-MRI data regarding RV performance and RV-PA coupling efficiency (n'vv [RV stroke volume/RV end-systolic volume]). The impact of RAC, RV data, and n'vv on ten-year survival were determined using Kaplan-Meier analysis. PH patients with a low ΔRAC (<-2.6%) had a worse long-term survival (log-rank P = 0.045, HR for death = 4.46 [95% CI = 1.08-24.5]) than those with ΔRAC ≥ -2.6%. Given the small sample, these data should be interpreted with caution; however, low ΔRAC was associated with an increase in stress diastolic PA area indicating proximal PA stiffening. Associations of borderline significance were observed between low RACSTRESS and low n'vvSTRESS, Δη'VV, and ΔRVEF. Further studies are required to validate the potential prognostic impact of ΔRAC and the biomechanics potentially connecting low ΔRAC to shorter survival. Such studies may facilitate development of novel PH therapies targeted to the proximal PA.
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Affiliation(s)
- Kevin G Blyth
- 1 Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK.,2 Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alessandro Bellofiore
- 3 Department of Biomedical, Chemical and Materials Engineering, San Jose State University, San Jose, CA, USA
| | - Geeshath Jayasekera
- 2 Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - John E Foster
- 4 Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, U.K
| | - Tracey Steedman
- 4 Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, U.K
| | - Naomi C Chesler
- 5 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew J Peacock
- 2 Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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26
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Panagiotou M, Vogiatzis I, Jayasekera G, Louvaris Z, Mackenzie A, Mcglinchey N, Baker JS, Church AC, Peacock AJ, Johnson MK. Validation of impedance cardiography in pulmonary arterial hypertension. Clin Physiol Funct Imaging 2017; 38:254-260. [DOI: 10.1111/cpf.12408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
| | - Ioannis Vogiatzis
- Faculty of Physical Education and Sports Sciences; National and Kapodistrian University of Athens; Athens Greece
- Faculty of Health and Life Sciences; Department of Sport; Exercise and Rehabilitation; Northumbria University; Newcastle UponTyne UK
| | - Geeshath Jayasekera
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
| | - Zafeiris Louvaris
- Faculty of Physical Education and Sports Sciences; National and Kapodistrian University of Athens; Athens Greece
- Faculty of Kinesiology and Rehabilitation Sciences; Department of Rehabilitation Sciences KU Leuven; Division of Respiratory Rehabilitation; University Hospitals Leuven; Belgium
| | - Alison Mackenzie
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
| | - Neil Mcglinchey
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
| | - Julien S. Baker
- Institute of Clinical Exercise and Health Science; University of the West of Scotland; Hamilton UK
| | - Alistair C. Church
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
| | - Martin K. Johnson
- Scottish Pulmonary Vascular Unit; Golden Jubilee National Hospital; Glasgow UK
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27
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Panagiotou M, Church AC, Johnson MK, Peacock AJ. Pulmonary vascular and cardiac impairment in interstitial lung disease. Eur Respir Rev 2017; 26:26/143/160053. [PMID: 28096284 PMCID: PMC9488566 DOI: 10.1183/16000617.0053-2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/02/2016] [Indexed: 12/19/2022] Open
Abstract
Pulmonary vascular and cardiac impairment is increasingly appreciated as a major adverse factor in the natural history of interstitial lung disease. This clinically orientated review focuses on the current concepts in the pathogenesis, pathophysiology and implications of the detrimental sequence of increased pulmonary vascular resistance, pre-capillary pulmonary hypertension and right heart failure in interstitial lung disease, and provides guidance on its management. Development of pulmonary hypertension is a major adverse factor in the natural history of interstitial lung diseasehttp://ow.ly/nJB0302XAmD
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Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Panagiotou M, Vogiatzis I, Louvaris Z, Jayasekera G, McKenzie A, Mcglinchey N, Baker JS, Church AC, Peacock AJ, Johnson MK. Dynamic near-infrared spectroscopy assessment as an important tool to explore pulmonary arterial hypertension pathophysiology. Eur Respir J 2017; 49:49/1/1602161. [PMID: 28052962 DOI: 10.1183/13993003.02161-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/09/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Ioannis Vogiatzis
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Zafeiris Louvaris
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Geeshath Jayasekera
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alison McKenzie
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Neil Mcglinchey
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Julien S Baker
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Sithamparanathan S, Nair A, Thirugnanasothy L, Coghlan JG, Condliffe R, Dimopoulos K, Elliot CA, Fisher AJ, Gaine S, Gibbs JSR, Gatzoulis MA, E Handler C, Howard LS, Johnson M, Kiely DG, Lordan JL, Peacock AJ, Pepke-Zaba J, Schreiber BE, Sheares KKK, Wort SJ, Corris PA. Survival in portopulmonary hypertension: Outcomes of the United Kingdom National Pulmonary Arterial Hypertension Registry. J Heart Lung Transplant 2016; 36:770-779. [PMID: 28190786 DOI: 10.1016/j.healun.2016.12.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Portopulmonary hypertension (PoPH) is a rare condition associated with poor survival, and the effect of modern therapies that target pulmonary arterial hypertension (PAH) on long-term outcome is unknown. This study investigated the baseline characteristics and survival in the cohort of patients diagnosed with PoPH in the United Kingdom National Pulmonary Hypertension Service. METHODS A retrospective review was conducted of all incident treatment-naïve patients with PoPH within the United Kingdom national registry diagnosed between January 2001 and December 2010. RESULTS Patients with PoPH (n = 110) had survival rates of 85%, 60%, and 35% at 1, 3, and 5 years. The prevalence of PoPH was 0.85 cases/1 million. Mean age at diagnosis was 53 ± 12 years, with a balanced distribution in gender. Alcohol (n = 57) and hepatitis C (n = 10) were the most common causes of portal hypertension. Phosphodiesterase V inhibitors were the most frequently used targeted therapy, in 63.6% (n = 70) of patients, endothelin receptor antagonists were used in 10% (n = 11) and prostacyclin analogs in 12.7% (n = 14). Univariate and multivariate analysis of baseline characteristics did not demonstrate a significant influence of severity of portal hypertension or liver cirrhosis, World Health Organization Functional Class, cardiopulmonary hemodynamics, or year of diagnosis on survival. CONCLUSIONS Survival of patients with PoPH remains poor despite targeted therapy and worse than patients with idiopathic PAH. The benefit of PAH therapies in PoPH on long-term morbidity and mortality outcomes needs further consideration and study.
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Affiliation(s)
- Sasiharan Sithamparanathan
- National Pulmonary Hypertension Service (Newcastle), The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Arun Nair
- National Pulmonary Hypertension Service (Newcastle), The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Logan Thirugnanasothy
- National Pulmonary Hypertension Service (Newcastle), The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - J Gerry Coghlan
- Pulmonary Hypertension Unit, Royal Free Hospital, London, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Konstantinos Dimopoulos
- Royal Brompton Pulmonary Hypertension and Adult Congenital Heart Centre, Imperial College, London, United Kingdom
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Andrew J Fisher
- National Pulmonary Hypertension Service (Newcastle), The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sean Gaine
- Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College, London and Hammersmith Hospital, London, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton Pulmonary Hypertension and Adult Congenital Heart Centre, Imperial College, London, United Kingdom
| | - Clive E Handler
- Pulmonary Hypertension Unit, Royal Free Hospital, London, United Kingdom
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College, London and Hammersmith Hospital, London, United Kingdom
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, Scotland
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - James L Lordan
- National Pulmonary Hypertension Service (Newcastle), The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, Scotland
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom
| | | | - Karen K K Sheares
- Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom
| | - Stephen J Wort
- Royal Brompton Pulmonary Hypertension and Adult Congenital Heart Centre, Imperial College, London, United Kingdom
| | - Paul A Corris
- National Pulmonary Hypertension Service (Newcastle), The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
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30
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Coghlan JG, Galiè N, Barberà JA, Frost AE, Ghofrani HA, Hoeper MM, Kuwana M, McLaughlin VV, Peacock AJ, Simonneau G, Vachiéry JL, Blair C, Gillies H, Miller KL, Harris JHN, Langley J, Rubin LJ. Initial combination therapy with ambrisentan and tadalafil in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH): subgroup analysis from the AMBITION trial. Ann Rheum Dis 2016; 76:1219-1227. [PMID: 28039187 PMCID: PMC5530350 DOI: 10.1136/annrheumdis-2016-210236] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/02/2016] [Accepted: 12/03/2016] [Indexed: 11/28/2022]
Abstract
Background Patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH), in particular systemic sclerosis (SSc), had an attenuated response compared with idiopathic PAH in most trials. Thus, there is uncertainty regarding the benefit of PAH-targeted therapy in some forms of CTD-PAH. Objective To explore the safety and efficacy of initial combination therapy with ambrisentan and tadalafil versus ambrisentan or tadalafil monotherapy in patients with CTD-PAH and SSc-PAH enrolled in the AMBITION trial. Methods This was a post hoc analysis of patients with CTD-PAH and SSc-PAH from AMBITION, an event-driven, double-blind trial in patients with WHO functional class II/III PAH. Treatment-naive patients were randomised 2:1:1 to once-daily initial combination therapy with ambrisentan plus tadalafil or monotherapy with ambrisentan or tadalafil, respectively. The primary endpoint was time to the first clinical failure event (first occurrence of death, hospitalisation for worsening PAH, disease progression or unsatisfactory long-term clinical response). Results In the primary analysis set (N=500), 187 patients had CTD-PAH, of whom 118 had SSc-PAH. Initial combination therapy reduced the risk of clinical failure versus pooled monotherapy in each subgroup: CTD-PAH (HR 0.43 (95% CI 0.24 to 0.77)) and SSc-PAH (0.44 (0.22 to 0.89)). The most common AE was peripheral oedema, which was reported more frequently with initial combination therapy than monotherapy in the two PAH subgroups. The relative frequency of adverse events between those on combination therapy versus monotherapy was similar across subgroups. Conclusions This post hoc subgroup analysis provides evidence that CTD-PAH and SSc-PAH patients benefit from initial ambrisentan and tadalafil combination therapy. Trial registration number NCT01178073, post results.
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Affiliation(s)
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Joan Albert Barberà
- Department of Respiratory Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | | | | | - Marius M Hoeper
- Hannover Medical School and German Center of Lung Research (DZL) Hannover, Hannover, Germany
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | | | - Gérald Simonneau
- Faculté de Médecine, Université Paris-Sud, Le Kremlin Bicêtre, France.,Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.,Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), UMR_S 999, INSERM, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | | | | | - Hunter Gillies
- Former employee of Gilead Sciences, Inc., Foster City, California, USA
| | | | | | | | - Lewis J Rubin
- University of California at San Diego, La Jolla, California, USA
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31
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Crowe TM, Sonecki P, Mackenzie A, Jayasekera G, Church AC, Johnson MK, Peacock AJ. S110 2-d segmental longitudinal strain rates correlate with prognostic indicators in idiopathic pulmonary arterial hypertension. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rhodes CJ, Ghataorhe P, Wharton J, Rue-Albrecht KC, Hadinnapola C, Watson G, Bleda M, Haimel M, Coghlan G, Corris PA, Howard LS, Kiely DG, Peacock AJ, Pepke-Zaba J, Toshner MR, Wort SJ, Gibbs JSR, Lawrie A, Gräf S, Morrell NW, Wilkins MR. Plasma Metabolomics Implicates Modified Transfer RNAs and Altered Bioenergetics in the Outcomes of Pulmonary Arterial Hypertension. Circulation 2016; 135:460-475. [PMID: 27881557 PMCID: PMC5287439 DOI: 10.1161/circulationaha.116.024602] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Pulmonary arterial hypertension (PAH) is a heterogeneous disorder with high mortality. Methods: We conducted a comprehensive study of plasma metabolites using ultraperformance liquid chromatography mass spectrometry to identify patients at high risk of early death, to identify patients who respond well to treatment, and to provide novel molecular insights into disease pathogenesis. Results: Fifty-three circulating metabolites distinguished well-phenotyped patients with idiopathic or heritable PAH (n=365) from healthy control subjects (n=121) after correction for multiple testing (P<7.3e-5) and confounding factors, including drug therapy, and renal and hepatic impairment. A subset of 20 of 53 metabolites also discriminated patients with PAH from disease control subjects (symptomatic patients without pulmonary hypertension, n=139). Sixty-two metabolites were prognostic in PAH, with 36 of 62 independent of established prognostic markers. Increased levels of tRNA-specific modified nucleosides (N2,N2-dimethylguanosine, N1-methylinosine), tricarboxylic acid cycle intermediates (malate, fumarate), glutamate, fatty acid acylcarnitines, tryptophan, and polyamine metabolites and decreased levels of steroids, sphingomyelins, and phosphatidylcholines distinguished patients from control subjects. The largest differences correlated with increased risk of death, and correction of several metabolites over time was associated with a better outcome. Patients who responded to calcium channel blocker therapy had metabolic profiles similar to those of healthy control subjects. Conclusions: Metabolic profiles in PAH are strongly related to survival and should be considered part of the deep phenotypic characterization of this disease. Our results support the investigation of targeted therapeutic strategies that seek to address the alterations in translational regulation and energy metabolism that characterize these patients.
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Affiliation(s)
- Christopher J Rhodes
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Pavandeep Ghataorhe
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - John Wharton
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Kevin C Rue-Albrecht
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Charaka Hadinnapola
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Geoffrey Watson
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Marta Bleda
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Matthias Haimel
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Gerry Coghlan
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Paul A Corris
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Luke S Howard
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - David G Kiely
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Andrew J Peacock
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Joanna Pepke-Zaba
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Mark R Toshner
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - S John Wort
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - J Simon R Gibbs
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Allan Lawrie
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Stefan Gräf
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Nicholas W Morrell
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.)
| | - Martin R Wilkins
- From the Department of Medicine, Imperial College London, Hammersmith Campus, United Kingdom (C.J.R., P.G., J.W., K.C.R.-A., G.W., M.R.W.); Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom (C.H., M.B., M.H., M.R.T., S.G., N.W.M.); Cardiology Department, Royal Free Hospital, London, United Kingdom (G.C.); Institute of Cellular Medicine, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.A.C.); National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (L.S.H., J.S.R.G.); National Heart and Lung Institute, Imperial College London, Hammersmith Campus, United Kingdom (L.S.H., J.S.R.G.); Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (D.G.K.); Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, United Kingdom (D.G.K., A.L.); Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.J.P.); Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom (J.P.Z., M.R.T.); Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom (S.J.W.); and Department of Haematology, University of Cambridge, United Kingdom (S.G.).
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Hoeper MM, McLaughlin VV, Barberá JA, Frost AE, Ghofrani HA, Peacock AJ, Simonneau G, Rosenkranz S, Oudiz RJ, White RJ, Miller KL, Langley J, Harris JHN, Blair C, Rubin LJ, Vachiery JL. Initial combination therapy with ambrisentan and tadalafil and mortality in patients with pulmonary arterial hypertension: a secondary analysis of the results from the randomised, controlled AMBITION study. The Lancet Respiratory Medicine 2016; 4:894-901. [DOI: 10.1016/s2213-2600(16)30307-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/01/2022]
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Panagiotou M, Vogiatzis I, Louvaris Z, Jayasekera G, MacKenzie A, Mcglinchey N, Baker JS, Church AC, Peacock AJ, Johnson MK. Near infrared spectroscopy for the assessment of peripheral tissue oxygenation in pulmonary arterial hypertension. Eur Respir J 2016; 48:1224-1227. [PMID: 27587562 DOI: 10.1183/13993003.01022-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/13/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Ioannis Vogiatzis
- National and Kapodistrian University of Athens, Dept of Physical Education and Sports Sciences, Athens, Greece
| | - Zafeiris Louvaris
- National and Kapodistrian University of Athens, Dept of Physical Education and Sports Sciences, Athens, Greece
| | - Geeshath Jayasekera
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alison MacKenzie
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Neil Mcglinchey
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Julien S Baker
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Reid GS, Wilson KS, Suveizdyte K, Brash L, Peacock AJ, Welsh DJ. P267 The effects of Apelin on serum NT-proBNP levels in Pulmonary Hypertension Patients versus Controls. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Noninvasive imaging of the heart plays an important role in the diagnosis and management of pulmonary hypertension (PH), and several well-established techniques are available for assessing performance of the right ventricle, the key determinant of patient survival. While right heart catheterisation is mandatory for establishing a diagnosis of PH, echocardiography is the most important screening tool for early detection of PH. Cardiac magnetic resonance imaging (CMRI) is also a reliable and practical tool that can be used as part of the diagnostic work-up. Echocardiography can measure a range of haemodynamic and anatomical variables (e.g. pericardial effusion and pulmonary artery pressure), whereas CMRI provides complementary information to echocardiography via high-resolution, three-dimensional imaging. Together with echocardiography and CMRI, techniques such as high-resolution computed tomography and positron emission tomography may also be valuable for screening, monitoring and follow-up assessments of patients with PH, but their clinical relevance has yet to be established. Technological advances have produced new variants of echocardiography, CMRI and positron emission tomography, and these permit closer examination of myocardial architecture, motion and deformation. Integrating these new tools into clinical practice in the future may lead to more precise noninvasive determination of diagnosis, risk and prognosis for PH.
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Reid GS, Wilson KS, Suveizdyte K, Brash L, Peacock AJ, Welsh DJ. 22 The effects of apelin on serum NT-proBNP levels in pulmonary hypertension patients. Heart 2015. [DOI: 10.1136/heartjnl-2015-308734.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wilson KS, Suveizdyte K, Liles J, Budas GR, Peacock AJ, Welsh DJ. 44 ASK-1 inhibition prevents hypoxia-induced pulmonary artery fibroblast proliferation and migration in an in vitrocellular model of pulmonary hypertension. Heart 2015. [DOI: 10.1136/heartjnl-2015-308734.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Frost AE, Barst RJ, Hoeper MM, Chang HJ, Frantz RP, Fukumoto Y, Galié N, Hassoun PM, Klose H, Matsubara H, Morrell NW, Peacock AJ, Pfeifer M, Simonneau G, Tapson VF, Torres F, Dario Vizza C, Lawrence D, Yang W, Felser JM, Quinn DA, Ghofrani HA. Long-term safety and efficacy of imatinib in pulmonary arterial hypertension. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.05.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Panagiotou M, Peacock AJ, Johnson MK. Respiratory and limb muscle dysfunction in pulmonary arterial hypertension: a role for exercise training? Pulm Circ 2015; 5:424-34. [PMID: 26401245 DOI: 10.1086/682431] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/04/2015] [Indexed: 11/03/2022] Open
Abstract
Respiratory and limb muscle dysfunction is emerging as an important pathophysiological abnormality in pulmonary arterial hypertension (PAH). Muscle abnormalities appear to occur frequently and promote dyspnea, fatigue, and exercise limitation in patients with PAH. Preliminary data suggest that targeted muscle training may be of benefit, although further evidence is required to consolidate these findings into specific recommendations for exercise training in patients with PAH. This article reviews the current evidence on prevalence, risk factors, and implications of respiratory and limb muscle dysfunction in patients with PAH. It also reviews the impact of exercise rehabilitation on morphologic, metabolic, and functional muscle profile and outcomes in PAH. Future research priorities are highlighted.
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Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, United Kingdom
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Galiè N, Barberà JA, Frost AE, Ghofrani HA, Hoeper MM, McLaughlin VV, Peacock AJ, Simonneau G, Vachiery JL, Grünig E, Oudiz RJ, Vonk-Noordegraaf A, White RJ, Blair C, Gillies H, Miller KL, Harris JHN, Langley J, Rubin LJ. Initial Use of Ambrisentan plus Tadalafil in Pulmonary Arterial Hypertension. N Engl J Med 2015; 373:834-44. [PMID: 26308684 DOI: 10.1056/nejmoa1413687] [Citation(s) in RCA: 751] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data on the effect of initial combination therapy with ambrisentan and tadalafil on long-term outcomes in patients with pulmonary arterial hypertension are scarce. METHODS In this event-driven, double-blind study, we randomly assigned, in a 2:1:1 ratio, participants with World Health Organization functional class II or III symptoms of pulmonary arterial hypertension who had not previously received treatment to receive initial combination therapy with 10 mg of ambrisentan plus 40 mg of tadalafil (combination-therapy group), 10 mg of ambrisentan plus placebo (ambrisentan-monotherapy group), or 40 mg of tadalafil plus placebo (tadalafil-monotherapy group), all administered once daily. The primary end point in a time-to-event analysis was the first event of clinical failure, which was defined as the first occurrence of a composite of death, hospitalization for worsening pulmonary arterial hypertension, disease progression, or unsatisfactory long-term clinical response. RESULTS The primary analysis included 500 participants; 253 were assigned to the combination-therapy group, 126 to the ambrisentan-monotherapy group, and 121 to the tadalafil-monotherapy group. A primary end-point event occurred in 18%, 34%, and 28% of the participants in these groups, respectively, and in 31% of the pooled-monotherapy group (the two monotherapy groups combined). The hazard ratio for the primary end point in the combination-therapy group versus the pooled-monotherapy group was 0.50 (95% confidence interval [CI], 0.35 to 0.72; P<0.001). At week 24, the combination-therapy group had greater reductions from baseline in N-terminal pro-brain natriuretic peptide levels than did the pooled-monotherapy group (mean change, -67.2% vs. -50.4%; P<0.001), as well as a higher percentage of patients with a satisfactory clinical response (39% vs. 29%; odds ratio, 1.56 [95% CI, 1.05 to 2.32]; P=0.03) and a greater improvement in the 6-minute walk distance (median change from baseline, 48.98 m vs. 23.80 m; P<0.001). The adverse events that occurred more frequently in the combination-therapy group than in either monotherapy group included peripheral edema, headache, nasal congestion, and anemia. CONCLUSIONS Among participants with pulmonary arterial hypertension who had not received previous treatment, initial combination therapy with ambrisentan and tadalafil resulted in a significantly lower risk of clinical-failure events than the risk with ambrisentan or tadalafil monotherapy. (Funded by Gilead Sciences and GlaxoSmithKline; AMBITION ClinicalTrials.gov number, NCT01178073.).
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Affiliation(s)
- Nazzareno Galiè
- From the Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy (N.G.); Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer and University of Barcelona, Barcelona, and Biomedical Research Networking Center on Respiratory Diseases, Madrid (J.A.B.); Baylor College of Medicine, Houston (A.E.F.); Universities of Giessen and Marburg Lung Center, Giessen (H.-A.G.), Hanover Medical School and German Center of Lung Research, Hanover (M.M.H.), and Thoraxklinik at University Hospital Heidelberg, Heidelberg (E.G.) - all in Germany; University of Michigan Health System, Ann Arbor (V.V.M.); Regional Heart and Lung Centre, Glasgow (A.J.P.), and GlaxoSmithKline, Uxbridge (J.H.N.H., J.L.) - both in the United Kingdom; Université Paris-Sud, Faculté de Médecine, and Assistance Publique-Hôpitaux de Paris, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire Thorax Innovation, Service de Pneumologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, INSERM Unité Mixté de Recherche S 999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson - all in France (G.S.); Universitaires de Bruxelles-Hôpital Erasme, Brussels (J.-L.V.); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance (R.J.O.), Gilead Sciences, Foster City (C.B., H.G., K.L.M.), and University of California at San Diego, La Jolla (L.J.R.) - all in California; VU University Medical Center, Amsterdam (A.V.-N.); and the University of Rochester, Rochester, NY (R.J.W.)
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Brewis MJ, Church AC, Johnson MK, Peacock AJ. Severe pulmonary hypertension in lung disease: phenotypes and response to treatment. Eur Respir J 2015; 46:1378-89. [DOI: 10.1183/13993003.02307-2014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/02/2015] [Indexed: 11/05/2022]
Abstract
Pulmonary hypertension (PH) due to lung disease (World Health Organization (WHO) group 3) is common, but severe PH, arbitrarily defined as mean pulmonary artery pressure ≥35 mmHg is reported in only a small proportion. Whether these should be treated as patients in WHO group 1 (i.e.pulmonary arterial hypertension) with PH-targeted therapies is unknown.We compared the phenotypic characteristics and outcomes of 118 incident patients with severe PH and lung disease with 74 idiopathic pulmonary arterial hypertension (IPAH) patients, all treated with pulmonary vasodilators.Lung disease patients were older, more hypoxaemic, and had lower gas transfer, worse New York Heart Association functional class and lower 6-min walking distance (6MWD) than IPAH patients. Poorer survival in those with lung disease was driven by the interstitial lung disease (ILD) cohort.In contrast to IPAH, where significant improvements in 6MWD and N-terminal pro-brain natruiretic peptide (NT-proBNP) occurred, PH therapy in severe PH lung disease did not lead to improvement in 6MWD or functional class, but neither was deterioration seen. NT-proBNP decreased from 2200 to 1596 pg·mL−1(p=0.015). Response varied by lung disease phenotype, with poorer outcomes in patients with ILD and emphysema with preserved forced expiratory volume in 1 s. Further study is required to investigate whether vasodilator therapy may delay disease progression in severe PH with lung disease.
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Church AC, Martin DH, Wadsworth R, Bryson G, Fisher AJ, Welsh DJ, Peacock AJ. The reversal of pulmonary vascular remodeling through inhibition of p38 MAPK-alpha: a potential novel anti-inflammatory strategy in pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2015; 309:L333-47. [PMID: 26024891 PMCID: PMC4538235 DOI: 10.1152/ajplung.00038.2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/26/2015] [Indexed: 01/14/2023] Open
Abstract
The p38 mitogen-activated protein kinase (MAPK) system is increasingly recognized as an important inflammatory pathway in systemic vascular disease but its role in pulmonary vascular disease is unclear. Previous in vitro studies suggest p38 MAPKα is critical in the proliferation of pulmonary artery fibroblasts, an important step in the pathogenesis of pulmonary vascular remodeling (PVremod). In this study the role of the p38 MAPK pathway was investigated in both in vitro and in vivo models of pulmonary hypertension and human disease. Pharmacological inhibition of p38 MAPKα in both chronic hypoxic and monocrotaline rodent models of pulmonary hypertension prevented and reversed the pulmonary hypertensive phenotype. Furthermore, with the use of a novel and clinically available p38 MAPKα antagonist, reversal of pulmonary hypertension was obtained in both experimental models. Increased expression of phosphorylated p38 MAPK and p38 MAPKα was observed in the pulmonary vasculature from patients with idiopathic pulmonary arterial hypertension, suggesting a role for activation of this pathway in the PVremod A reduction of IL-6 levels in serum and lung tissue was found in the drug-treated animals, suggesting a potential mechanism for this reversal in PVremod. This study suggests that the p38 MAPK and the α-isoform plays a pathogenic role in both human disease and rodent models of pulmonary hypertension potentially mediated through IL-6. Selective inhibition of this pathway may provide a novel therapeutic approach that targets both remodeling and inflammatory pathways in pulmonary vascular disease.
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Affiliation(s)
- Alistair C Church
- Scottish Pulmonary Vascular Unit, University of Glasgow, Glasgow, United Kingdom;
| | - Damien H Martin
- Scottish Pulmonary Vascular Unit, University of Glasgow, Glasgow, United Kingdom
| | - Roger Wadsworth
- Department of Cardiovascular Biology, University of Strathclyde, Glasgow, United Kingdom
| | - Gareth Bryson
- Department of Pathology, Southern General Hospital, Glasgow, United Kingdom; and
| | - Andrew J Fisher
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David J Welsh
- Scottish Pulmonary Vascular Unit, University of Glasgow, Glasgow, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, University of Glasgow, Glasgow, United Kingdom
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Brewis MJ, Church AC, Peacock AJ, Thomson S, Tighe J, Johnson MK. Pulmonary hypertension in POEMS syndrome: resolution following radiotherapy. Pulm Circ 2015; 4:732-5. [PMID: 25610609 DOI: 10.1086/678553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/13/2014] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension (PH) is defined by the presence of a mean pulmonary artery pressure (mPAP) ≥25 mmHg. It may be idiopathic or arise as a consequence of a number of diverse conditions. PH has been reported in association with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes), with reversal following systemic treatment with corticosteroids. We report a case of pulmonary hypertension associated with POEMS syndrome treated with radical radiotherapy locally to bone lesions with resolution of systemic disease.
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Affiliation(s)
- Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Stephen Thomson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Jane Tighe
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
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Abstract
OBJECTIVE To provide an overview of the drug profile of the orally active, selective endothelin A receptor antagonist ambrisentan, and its efficacy and safety in the treatment of patients with pulmonary arterial hypertension (PAH). RESEARCH DESIGN AND METHODS Medical literature on the use of ambrisentan in PAH was identified using MEDLINE and EMBASE. Additional references were identified from the reference lists of published articles and from the authors' own bibliographies. RESULTS Significant improvements in exercise capacity were observed with approved dosages of ambrisentan (5 or 10 mg once daily) in the AMB-220 dose-ranging study and the pivotal ARIES-1 and ARIES-2 trials, with sustained effects up to 2 years observed in ARIES-E. Improvements in cardiopulmonary hemodynamic variables were reported in AMB-220 and ARIES-E (subset analysis). Ambrisentan had little or no effect on hepatic transporters in in vitro studies and displayed a low risk of potential drug-drug interactions, including those with other PAH therapies. Results from the VOLT post-marketing program confirmed the safety profile of ambrisentan observed in the ARIES studies, including the low incidence of liver function test abnormalities. Peripheral edema and anemia were common side effects of endothelin receptor antagonist therapies, including ambrisentan. In the recently completed AMBITION study (ClinicalTrials.gov Identifier: NCT01178073), upfront initial combination therapy with ambrisentan and tadalafil significantly reduced the risk of clinical failure (primary endpoint) by 50% compared with the pooled monotherapy groups. CONCLUSIONS The long-term efficacy and safety profile of ambrisentan in patients with PAH is supported by data from a comprehensive clinical trial program and real-life, post-marketing observations.
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Affiliation(s)
- Andrew J Peacock
- a a Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre , Glasgow , UK
| | - William Zamboni
- b b European Immunology and Rare Diseases Unit, GlaxoSmithKline SpA , Verona , Italy
| | - Carmine Dario Vizza
- c c Pulmonary Hypertension Unit, Department of Cardiovascular and Respiratory Disease, Sapienza University of Rome , Rome , Italy
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McGoon MD, Benza RL, Escribano-Subias P, Jiang X, Miller DP, Peacock AJ, Pepke-Zaba J, Pulido T, Rich S, Rosenkranz S, Suissa S, Humbert M. [Pulmonary arterial hypertension: epidemiology and registries]. Turk Kardiyol Dern Ars 2014; 42 Suppl 1:67-77. [PMID: 25697035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Registries of patients with pulmonary arterial hypertension (PAH) have been instrumental in characterizing the presentation and natural history of the disease and provide a basis for prognostication. Since the initial accumulation of data conducted in the 1980s, subsequent registry databases have yielded information about the demographic factors, treatment, and survival of patients and have permitted comparisons between populations in different eras and environments. Inclusion of patients with all subtypes of PAH has also allowed comparisons of these subpopulations. We describe herein the basic methodology by which PAH registries have been conducted, review key insights provided by registries, summarize issues related to interpretation and comparison of the results, and discuss the utility of data to predict survival outcomes. Potential sources of bias, particularly related to the inclusion of incident and/or prevalent patients and missing data, are addressed. A fundamental observation of current registries is that survival in the modern treatment era has improved compared with that observed previously and that outcomes among PAH subpopulations vary substantially. Continuing systematic clinical surveillance of PAH will be important as treatment evolves and as understanding of mechanisms advance. Considerations for future directions of registry studies include enrollment of a broader population of patients with pulmonary hypertension of all clinical types and severity and continued globalization and collaboration of registry databases. (J Am Coil Cardiol 2013;62:D51-9) ©2013 by the American College of Cardiology Foundation.
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Crawley SF, Johnson MK, Dargie HJ, Peacock AJ. LA volume by CMR distinguishes idiopathic from pulmonary hypertension due to HFpEF. JACC Cardiovasc Imaging 2014; 6:1120-1121. [PMID: 24135327 DOI: 10.1016/j.jcmg.2013.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
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McGlinchey N, Peacock AJ. Endpoints in PAH clinical trials in the era of combination therapy: how do we decide whether something is working without going bankrupt? Drug Discov Today 2014; 19:1236-40. [PMID: 24814434 DOI: 10.1016/j.drudis.2014.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/30/2014] [Indexed: 11/29/2022]
Abstract
There has been substantial progress in the treatment of pulmonary arterial hypertension using specific disease-targeted therapies. As the number of agents available grows, and as new treatment strategies emerge, it is essential that the endpoints we use to assess efficacy are sufficiently meaningful and sensitive enough to detect changes that are often subtle. Although the six-minute walk has been the traditional primary endpoint in clinical trials, there is now a move towards more patient-centred composite endpoints such as time to clinical worsening. These endpoints need to be more clearly defined and universally applied so as to make direct comparison between new drugs and new combinations possible.
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Affiliation(s)
- Neil McGlinchey
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, G81 4HX, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, G81 4HX, UK.
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Abstract
Hypoxia can be defined as a reduction in available oxygen, whether in a whole organism or in a tissue or cell. It is a real life cause of pulmonary hypertension in humans both in terms of patients with chronic hypoxic lung disease and people living at high altitude. The effect of hypoxia on the pulmonary vasculature can be described in two ways; Hypoxic pulmonary vasoconstriction (HPV) (resulting from smooth muscle cell contraction) and pulmonary vascular remodelling (PVR) (resulting from pulmonary vascular cell proliferation). The pulmonary artery is made up of three resident cell types, the endothelial (intima), smooth muscle (media) and fibroblast (adventitia) cells. This review will examine the effects of hypoxia on the cells of the pulmonary vasculature and give an insight into the possible underlying mechanisms.
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Affiliation(s)
- David J Welsh
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Center, Glasgow, United Kingdom
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