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芬戈莫德(捷灵亚)治疗多发性硬化症:心动过缓、房室传导阻滞以及对QTc间期的轻微影响。与L型钙通道有关?

Fingolimod (Gilenya ) in multiple sclerosis: bradycardia, atrioventricular blocks, and mild effect on the QTc interval. Something to do with the L-type calcium channel?

作者信息

Pilote Sylvie, Simard Chantale, Drolet Benoit

机构信息

Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), 2725, Chemin Sainte-Foy, Québec, QC, Canada, G1V 4G5.

Faculté de Pharmacie, Université Laval, 1050 Avenue de la médecine, Québec, QC, Canada, G1V 0A6.

出版信息

Fundam Clin Pharmacol. 2017 Aug;31(4):392-402. doi: 10.1111/fcp.12284. Epub 2017 Apr 26.

Abstract

Cardiac arrhythmias and ECG abnormalities including bradycardia, prolongation of the QT interval, and atrioventricular (AV) conduction blocks have been extensively observed with fingolimod, the first marketed oral drug for treating the relapsing-remitting form of multiple sclerosis. This study was aiming to further elucidate the effects of fingolimod on cardiac electrophysiology at three different levels: (i) in vitro, (ii) ex vivo, and (iii) in vivo. (i) Patch-clamp experiments in whole cell configuration were performed on Ca 1.2-transfected tsA201 cells exposed to fingolimod-phosphate 100 or 500 nmol/L (n = 27 cells, total) to measure drug effect on L-type calcium current (I ). (ii) Langendorff perfusion experiments were undertaken on male Hartley guinea-pigs isolated hearts (n = 4) exposed to fingolimod 10 and 100 nmol/L to evaluate drug-induced effects on monophasic action potential duration measured at 90% repolarization (MAPD ). (iii) Implanted cardiac telemeters were used to record ECGs in guinea-pigs (n = 7) treated with a single dose of fingolimod 0.0625 mg/kg suspension, administered as an oral gavage. (i) In vitro cellular experiments showed that fingolimod-phosphate causes a concentration-dependent reduction in I . (ii) Ex vivo Langendorff experiments revealed that fingolimod had no significant effect on MAPD . (iii) Fingolimod caused significant prolongations of the RR, PR, QT, and QTc intervals in vivo. Reversible AV blocks were also observed in 7/7 animals. Fingolimod possesses I -blocking properties, further contributing to its AV conduction-slowing effects. These properties are also consistent with its mitigated effect on the QT interval in humans, despite previously shown HERG-blocking effect.

摘要

心脏心律失常和心电图异常,包括心动过缓、QT间期延长和房室传导阻滞,在芬戈莫德(第一种上市的用于治疗复发缓解型多发性硬化症的口服药物)治疗过程中已被广泛观察到。本研究旨在从三个不同层面进一步阐明芬戈莫德对心脏电生理学的影响:(i)体外,(ii)离体,以及(iii)体内。(i)对转染了Ca 1.2的tsA201细胞进行全细胞模式的膜片钳实验,这些细胞暴露于100或500 nmol/L的磷酸芬戈莫德(共27个细胞),以测量药物对L型钙电流(I )的影响。(ii)对雄性Hartley豚鼠的离体心脏(n = 4)进行Langendorff灌注实验,这些心脏暴露于10和100 nmol/L的芬戈莫德,以评估药物对在复极化90%时测量的单相动作电位持续时间(MAPD90)的诱导作用。(iii)植入式心脏遥测仪用于记录经单剂量0.0625 mg/kg芬戈莫德悬浮液灌胃给药的豚鼠(n = 7)的心电图。(i)体外细胞实验表明,磷酸芬戈莫德导致I 浓度依赖性降低。(ii)离体Langendorff实验显示,芬戈莫德对MAPD90没有显著影响。(iii)芬戈莫德在体内导致RR、PR、QT和QTc间期显著延长。在7只动物中还观察到了可逆性房室传导阻滞。芬戈莫德具有I 阻断特性,这进一步促成了其减慢房室传导的作用。尽管之前显示有HERG阻断作用,但这些特性也与其对人类QT间期的减轻作用相一致。

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