Department of Cardiothoracic Surgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China ; The Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada ; Institute for Anesthesiology, German Heart Institute, Berlin, Berlin, Germany ; Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
PLoS One. 2013 Sep 19;8(9):e75861. doi: 10.1371/journal.pone.0075861. eCollection 2013.
Stable analogs of vasoactive intestinal peptide (VIP) have been proposed as novel line of therapy in chronic obstructive pulmonary disease (COPD) based on their bronchodilatory and anti-inflammatory effects. We speculated that VIP analogs may provide additional benefits in that they exert vasodilatory properties in the lung, and tested this hypothesis in both ex vivo and in vivo models.
In isolated perfused mouse lungs and in an in vivo rat model, pulmonary blood vessels were preconstricted by hypoxia and hemodynamic changes in response to systemic (ex vivo) or inhaled (in vivo) administration of the cyclic VIP analog RO 25-1553 were determined.
In mouse lungs, RO 25-1553 reduced intrinsic vascular resistance at normoxia, and attenuated the increase in pulmonary artery pressure in response to acute hypoxia. Consistently, inhalation of RO 25-1553 (1 mg · mL(-1) for 3 min) caused an extensive and sustained (> 60 min) inhibition of the pulmonary arterial pressure increase in response to hypoxia in vivo that was comparable to the effects of inhaled sildenafil. This effect was not attributable to systemic cardiovascular effects of RO 25-1553, but to a lung specific reduction in pulmonary vascular resistance, while cardiac output and systemic arterial hemodynamics remained unaffected. No adverse effects of RO 25-1553 inhalation on pulmonary gas exchange, ventilation-perfusion matching, or lung fluid content were detected.
Our findings demonstrate that inhaled delivery of the stable VIP analog RO 25-1553 induces a potent and sustained vasodilatory effect in the pulmonary circulation with no detectable adverse effects. Therapeutic inhalation of RO 25-1553 may provide vascular benefits in addition to its reported anti-inflammatory and bronchodilatory effects in COPD, yet caution is warranted given the overall poor results of vasodilator therapies for pulmonary hypertension secondary to COPD in a series of recent clinical trials.
基于血管活性肠肽(VIP)的支气管扩张和抗炎作用,稳定的 VIP 类似物被提议作为慢性阻塞性肺疾病(COPD)的新型治疗方法。我们推测 VIP 类似物可能具有额外的益处,因为它们在肺部发挥血管扩张特性,并在离体和体内模型中检验了这一假设。
在离体灌注的小鼠肺和体内大鼠模型中,通过低氧预收缩肺血管,并测定系统(离体)或吸入(体内)给予环状 VIP 类似物 RO 25-1553 后血液动力学的变化。
在小鼠肺中,RO 25-1553 在常氧下降低了固有血管阻力,并减弱了急性低氧时肺动脉压的升高。一致地,吸入 RO 25-1553(1 mg·mL(-1),3 min)可引起体内低氧反应中肺动脉压升高的广泛而持续(>60 min)抑制,与吸入西地那非的作用相当。这种作用不是由于 RO 25-1553 的全身心血管作用引起的,而是由于肺特异性降低肺血管阻力,而心输出量和全身动脉血液动力学不受影响。未发现 RO 25-1553 吸入对肺气体交换、通气-灌注匹配或肺液含量有不良影响。
我们的研究结果表明,稳定的 VIP 类似物 RO 25-1553 的吸入给药可在肺循环中引起强大而持久的血管扩张作用,且无明显不良反应。RO 25-1553 的治疗性吸入可能除了在 COPD 中报告的抗炎和支气管扩张作用外,还提供血管益处,但鉴于最近一系列临床试验中 COPD 引起的肺动脉高压的血管扩张治疗的总体结果不佳,需要谨慎。