PHCentral News is gathered daily to bring you the latest developments in pulmonary hypertension treatments and research as well as stories we think are useful on an array of topics. Under current news, you will find a dynamic list of stories for the last thirty (30) days. You will find older news stories in our archives. Stories about specific treatments can also be found in the medical section.
If you run across a PH news story we've missed or important story with broad appeal, please send us the link and we'll make sure it gets added. Send news: contact/info+phcentral+org.
- December 10, 2013
- Noninvasive Cardiac Output Measurement by Inert Gas Rebreathing in Suspected Pulmonary Hypertension.
The objective of this study was to evaluate inert gas rebreathing (IGR) reliability in cardiac output (CO) measurement compared with Fick method and thermodilution. IGR is a noninvasive method for CO measurement; CO by IGR is calculated as pulmonary blood flow plus intrapulmonary shunt. IGR may be ideal for follow-up of patients with pulmonary hypertension (PH), sparing the need of repeated invasive right-sided cardiac catheterization..
..In conclusion, IGR is reliable for CO measurement in patients with PH with arterial SO2 >90%. For patients with arterial SO2 ≤90%, a new formula for shunt calculation is proposed.
- December 9, 2013
- Cell permeable peptides (CPP) can block selected functions of a reveptor
Cell permeable peptides (CPP) aid cellular uptake of targeted cargo across the hydrophobic plasma membrane. CPP-mediated cargo delivery of receptor signaling motifs provides an opportunity to regulate specific receptor initiated signaling cascades. Both endothelin-1 receptors, ETA and ETB, have been targets of antagonist therapies for individuals with pulmonary arterial hypertension (PAH). These therapies have had success but have been accompanied by adverse reactions. Also, unlike the CPP which target specific signaling cascades, the antagonists target the entire function of the receptor. Using the CPP strategy of biased antagonism of the ETB receptor's intracellular loop 2 (ICB2), we demonstrate blunting of hypoxic pulmonary hypertension (HPH) in the rat, including indices of pulmonary arterial pressure, right ventricular hypertrophy and pulmonary vascular remodeling..
- December 8, 2013
- Chew More, Eat Less? It Could Work, Study Suggests
People who increased the number of times they chewed their food before swallowing ate less over the course of a meal. It has been observed that slow eaters tend to be slimmer but researchers didn't know whether asking people to chew more would change the amount of food they ate. This study showed that meal sizes shrunk when adults chewed extra before swallowing - whether they were normal weight, overweight or obese.
- Benefits and Costs of Home-Based Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease
Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease (COPD) to improve exercise capacity, symptoms and quality of life, however only a minority of individuals with COPD are able to participate. Travel and transport are frequently cited as barriers to uptake of centre-based programs. Other models of pulmonary rehabilitation, including home-based programs, have been proposed in order to improve access to this important treatment.
- December 7, 2013
- Sodium in Effervescent Painkillers, Vitamins Ups CVD Risk
Effervescent or readily soluble formats of common medications, such as painkillers and vitamin supplements, contain high levels of "hidden" sodium, which was linked with an increased risk of cardiovascular events, researchers report.
- Allergies and ACE Inhibitors a Dangerous Combination
People with hay fever who suddenly develop severe oral allergies should be screened for angiotensin-converting enzyme (ACE) inhibitor use, which can trigger these symptoms, research shows.
"ACE inhibitors can cause angioedema shortly after the medication is started, or sometimes months or years later, and can result in severe and sudden symptom onset," said senior investigator Sunit Jariwala, MD, from the Albert Einstein College of Medicine in the Bronx, New York.
- December 6, 2013
- Vitamin D Dosing: Too Low to Matter?
After reviewing 290 prospective studies and 172 randomized trials, vitamin D sufficiency appeared to provide a protective benefit from multiple diseases and all-cause mortality, while vitamin D deficiency increased the risk of disease occurrence and progression, according to Philippe Autier, MD, MPH, of the International Prevention Research Institute in Lyon, France, and colleagues.
- December 5, 2013
- New mitochondrial research may ultimately offer hope to those suffering
Queen’s University professor Stephen Archer’s (Department of Medicine) research has revealed that in serious human diseases (such as pulmonary hypertension, lung cancer, cardiac arrest and neurologic disease) the cell’s power source, known as mitochondria, displays an abnormal structure.
- Strategy Achieves Population-Wide Sodium Reduction
Results of a randomized trial with the aim of reducing sodium intake on a population level show that an intervention that included subsidizing the purchase of a salt substitute reduced 24-hour sodium excretion, although effects on blood pressure were not significant.
- December 4, 2013
- New Recommendations to Doctors for Treating Sleep Apnea
For adults with obstructive sleep apnea, using CPAP therapy or other airway-opening devices are one of the best courses of action to treat their sleep disorder. Overweight and obese adults with sleep apnea should also be encouraged and helped to lose weight as part of treating sleep apnea.
- December 3, 2013
- Converting stem cells into lung cells
(Medical News Today)
Researchers from the Columbia University Medical Center claim they are one step closer to generating lung tissue for transplant using a patient's own cells.
- FDA Grants Astellas Qualified Infectious Disease Product Designation for Isavuconazole for the Treatment of Invasive Aspergillosis
Astellas Pharma US, Inc., a subsidiary of Astellas Pharma Inc. based in Tokyo, Japan, announced today that the U.S. Food and Drug Administration (FDA) designated isavuconazole as a Qualified Infectious Disease Product (QIDP) for the treatment of invasive aspergillosis. QIDP status provides priority review and a five-year extension of market exclusivity if a product receiving such a designation is approved in the United States. These incentives were granted under the 2012 U.S. Generating Antibiotic Incentives Now (GAIN) Act as part of the FDA Safety and Innovation Act.
- December 2, 2013
- Hormone levels help predict survival in lung disease
A study shows that levels of brain natriuretic peptide can predict pulmonary hypertension among those with a range of lung diseases.
- New horizons in pulmonary arterial hypertension therapies
A very complete full text overview on current and future therapeutic options
- December 1, 2013
- Tacrolimus a Prospect for Connective Tissue Lung Disease
Tacrolimus may be an option for patients with interstitial lung disease related to connective tissue difficulties, new research suggests.
- EC Approves Fluticasone Furoate/Vilanterol for Asthma, COPD
The European Commission has granted marketing approval for fluticasone furoate/vilanterol (FF/VI) (Relvar Ellipta, GlaxoSmithKline and Theravance) for the treatment of asthma and chronic obstructive pulmonary disease (COPD), the companies announced today in a joint news release.
- November 30, 2013
- Cardiovascular Disease in Pregnancy
Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.
- New Obstructive Sleep Apnea Guideline: The Takeaways
On September 24, the American College of Physicians (ACP) published a new clinical practice guideline regarding the management of obstructive sleep apnea (OSA) in adults. The publication summarizes a portion of the known literature, highlights some of the detrimental effects of OSA, and discusses the benefits and limitations of the available treatment options
- November 29, 2013
- microRNA therapy for pulmonary arterial hypertension
(Frontiers in GENETICS)
In its advanced stage, PAH demonstrates muscularization of distal pulmonary arterioles, concentric thickening, and obstruction of vascular lumen due to the proliferation of pulmonary artery endothelial cells (PAECs) and pulmonary artery smooth muscle cells (PASMCs)
..With the use of experimental models of rodents and human alveolar-endothelial and smooth muscle cells at different stages of their study, Kim et al. have provided an extraordinary sense of optimism in the scientific community's search for more insights in pulmonary pathogenesis.
Interestingly, Kim et al.'s study results suggested that these miRNAs could affect proliferation of PASMCs in a paracrine manner. (Paracrine defn.- Proteins synthesized by one cell can diffuse over small distances to induce changes in neighboring cells, the event is called a paracrine interaction-http://www.ncbi.nlm.nih.gov/books/NBK10071/ )
Kim et al.'s findings and other miRNA related studies will provide a foundation for exploration of therapeutic models for finding a cure for PAH.
- November 28, 2013
- New hope for Nutlin-3a therapy for pulmonary arterial hypertension
(Frontiers in Pharmacology)
In the last decade, a good line of evidence has revealed that there is a variety of similarities existent between PH and cancer (McMurtry et al., 2005; Dromparis et al., 2010; Aljubran et al., 2012). Two representatives of them are uncontrolled cellular proliferation and resistance to apoptosis.
In the recent issue of Circulation, Mouraret et al. present an elegant study on the effects of Nutlin-3a on PH (Mouraret et al., 2013). Nutlin-3a, which is a cis-imidazoline analog, was originally developed as an anti-cancer drug.
Mouraret et al. revealed that a p53 stabilizer Nutlin-3a reversed PH in three distinct experimental mouse models with only limited side effects noted in control mice without PH
...it appears that Nutlin-3a has a totally different mechanism of action from currently available drugs and that it is not directly associated with relaxation of smooth muscle and vasodilation of the pulmonary arteries, which lessens the concern about the side effects related to vasodilation.
If Nutlin-3a works well for treatment of PH patients and it becomes an approved therapeutic application, PH patients would be able to have more therapeutic options including combination therapies, which ultimately would lead to decreased number of PH patients with advanced stages.
...one minor drawback of using Nutlin-3a as a potential PH treatment is its slow clinical effect on the patients with severe PH due to its lack of direct vasodilatory effect. However, in spite of the above mentioned disadvantage, this new drug still has an enormous therapeutic potential for treatment of PH. The day may come before long when Nutlin-3a will come out as a blessing for PH patients.
- Anesthesiology: Perioperative Management of the Patient with Severe Lung Disease
The goal of this program is to improve anesthetic management of patients with severe lung disease. After hearing and assimilating this program, the clinician will be better able to:
1. Explain the pathophysiology of bullae and the risks they present.
2. Use arterial blood gases to direct the anesthetic management of patients with chronic obstructive pulmonary disease.
3. Avoid or effectively treat dynamic hyperinflation.
4. Recognize differences in behavior of right-heart vs left-heart pulmonary hypertension during anesthesia.
5. Monitor right ventricular function in patients with pulmonary hypertension
- November 27, 2013
- Idiopathic pulmonary fibrosis strongly linked to herpesvirus infection
Is Idiopathic Pulmonary Fibrosis Caused by a Virus?
The cause(s) of idiopathic pulmonary fibrosis have vexed researchers for decades. Although risk factors (smoking, familial gene mutations) provide clues, the actual trigger for the proliferative, fibrotic cellular process resulting in usual interstitial pneumonitis (on biopsy specimens) and IPF (clinically) have remained frustratingly elusive.
Nuovo and colleagues suspected herpesvirus saimiri might have a causative role in IPF because the virus expresses a gene very similar to one found in regenerating epithelial cells in people with idiopathic pulmonary fibrosis. In people, epithelial cells expressing the gene secrete IL-17, a cytokine.
Viral infections, including Epstein-Barr virus (which causes mononucleosis), influenza A virus, hepatitis C virus, HIV, and herpes virus 6 have also long been known to be risk factors for development of idiopathic pulmonary fibrosis. (Viruses’ role in IPF exacerbations has been cast in doubt.)
“While the sample size is small,” Nuovo told an interviewer, “there are multiple data points that support our findings that herpesvirus saimiri infection may be the cause of IPF.”
- Ambrisentan (Letairis) stopped early in IPF trial
A large phase III randomized trial testing Ambrisentan (Letairis) for early idiopathic pulmonary fibrosis was stopped early after an interim analysis of the data showed possible harm.
Patients being treated with Letairis had more evidence of progression of idiopathic pulmonary fibrosis and were hospitalized more often, including diagnoses of acute exacerbations of IPF and pneumonia.
- November 26, 2013
- Researchers work to block kidney, lung damage and pain in sickle cell disease
Restoring a balance of the most powerful dilator and the most potent constrictor of blood vessels in the body could help patients with sickle cell disease avoid kidney and lung damage as well as pain, researchers say.
They believe drugs already on the market for pulmonary hypertension can turn down the inflammation and blood vessel constriction that results from the imbalance of nitric oxide and endothelin
- November 25, 2013
- The real PH-News: Watching Athletes Can Make You More Fit
Watching sport can make you fitter, according to research Sunday that said viewing other people exercise increases heart rate and other physiological measures as if you were working out yourself.
The study, published in the international journal Frontiers in Autonomic Neuroscience, showed that when watching a first person video of someone else running, heart rate, respiration, skin blood flow and sweat release all increased.
They returned to normal at the conclusion of the "jog".
Researchers said that importantly, for the first time, it was shown that muscle sympathetic nerve activity increased when people watched physical activity...
- November 24, 2013
- Management of Severe Pulmonary Arterial Hypertension
Despite advances in medical therapies, pulmonary arterial hypertension (PAH), continues to cause significant morbidity and mortality. Although, the right ventricle can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular (RV) failure. Furthermore, acute RV decompensation may develop from disorders that lead to either an acute increase in cardiac demand or an increase in ventricular afterload including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia, and adverse RV influence on left ventricular filling may lead to a global reduction in oxygen delivery and multiorgan failure. The authors present an approach to patients with advanced PAH focusing on both medical and surgical strategies to improve RV function based upon current evidence and physiological principles.
- Nut Consumption Linked to Lower Mortality
The frequency of nut consumption was inversely associated with total and cause-specific mortality independent of other predictors of death, according to a study from 2 large prospective US cohorts, published in the November 21 issue of the New England Journal of Medicine.
- November 23, 2013
- Update on the Potential Role of Statins in Chronic Obstructive Pulmonary Disease and its Co-morbidities
Chronic obstructive pulmonary disease (COPD) is soon to become the third leading cause of death in developed countries. COPD is increasingly considered a multisystem disease characterized by both pulmonary and systemic inflammation. Over the last 5 years, there have been a growing number of studies showing that the cholesterol-lowering drugs statins (HMG-CoA reductase inhibitors) have a beneficial effect in patients with COPD. While statins are known to have a number of pharmacological effects (pleiotropy) that could explain these benefits, it is currently not clear which effects are most relevant in COPD. This article reviews the most recently published studies of statin therapy in patients with COPD, focusing on the important COPD co-morbidities of the pulmonary system (infective exacerbations, pneumonia, influenza and lung cancer) and cardiovascular system (acute coronary syndrome, endothelial dysfunction and pulmonary hypertension). While we await the results of randomized controlled trials, there continues to be consistent (albeit indirect) evidence from observational studies suggesting statins are beneficial for patients with COPD, conferring important pharmacological effects on inflammation not conferred by current inhaler-based therapies.
- Acetaminophen and Alcohol May Be Nephrotoxic
The link between acetaminophen (Tylenol and generics) and liver damage is well established, but there is also evidence to suggest that in some asymptomatic patients, therapeutic doses of acetaminophen and light-to-moderate alcohol use can lead to renal disease.
- November 22, 2013
- Meprin beta, a novel mediator of vascular remodeling underlying pulmonary hypertension.
This study delineates a novel molecular mechanism underlying PASMC proliferation and extracellular matrix (ECM) deposition by identifying meprin β as an important mediator in regulating vascular remodeling processes. Thus meprin β may represent a new molecule that can be targeted in pulmonary hypertension.
- Paracrine Effects of Bone Marrow-Derived Endothelial Progenitor Cells: Cyclooxygenase-2/Prostacyclin Pathway in Pulmonary Arterial Hypertension.
Endothelial dysfunction is the pathophysiological characteristic of pulmonary arterial hypertension (PAH). Some paracrine factors secreted by bone marrow-derived endothelial progenitor cells (BMEPCs) have the potential to strengthen endothelial integrity and function. This study investigated whether BMEPCs have the therapeutic potential to improve monocrotaline (MCT)-induced PAH via producing vasoprotective substances in a paracrine fashion.
Implantation of BMEPCs effectively ameliorates MCT-induced PAH. Factors secreted in a paracrine fashion from BMEPCs promote vasoprotection by increasing the release of PGI2 and level of cAMP.
- November 21, 2013
- Comparison of the Therapeutic and Side Effects of Tadalafil and Sildenafil in Children and Adolescents with Pulmonary Arterial Hypertension.
- Circulating levels of copeptin predict outcome in patients with pulmonary arterial hypertension
Patients with PAH had elevated copeptin levels. High circulating levels of copeptin were independent predictors of poor outcome, which makes copeptin a potentially useful biomarker in PAH.
- November 20, 2013
- American Lung Association Offers Resources to help individuals with lung disease
(Amercian Lung Association)
Some interesting facts and tips about breathing
- Non-invasive PAH-screening in SSc using pulmonary function test and NT-proBNP
The combination of NT-proBNP with PFT is a sensitive, yet simple and non-invasive screening strategy for SSc-PAH. Patients with a positive screening result can be referred for echocardiography, and further confirmatory testing for PAH. In this way, it may be possible to shift the burden of routine screening away from echocardiography. The findings of this study should be confirmed in larger studies.
- November 19, 2013
- Lung transplantation in children. Specific aspects.
- Antioxidants & Redox Signaling
(Antioxid. Redox Signal. 18, 1810–1817.)
In human severe PAH, patient survival is determined by the function of the stressed right ventricle; investigation of oxidative and nitrosative stresses and their potential contribution to right heart failure is necessary. Future Directions: Antioxidant therapeutic strategies may be of benefit in the setting of human severe PAH. Whether antioxidant strategies affect lung vascular remodeling and/or prevent right heart failure remains to be examined. Source: Antioxid. Redox Signal. 18, 1810–1817.
- November 18, 2013
- FDA rejects approval of the Ventripoint Medical System for use in Pulmonary Arterial Hypertension
The FDA has found that despite achieving an average agreement between VMS and MRI results within the allowable 10% mean difference, the substantial equivalency was not sufficiently proven to warrant approval.
Management is currently reviewing the Company's options. Among them, is to apply for Premarket Approval (PMA) as a class III device, which would not require showing substantial equivalency.
"We are actively seeking the best avenue of approach to get the VMS(TM) to market. As a Company, we remain dedicated in our belief of the benefit our product has to offer the medical community as a whole, most importantly the patients. As such, we will continue to work within the FDA guidelines to meet the requirements necessary to achieve approval of the VMS(TM)," stated Dr. George Adams, CEO of Ventripoint. "This ruling has no affect on the Company's ability to market and sell the VMS(TM) outside the USA."
The VMS(TM) is approved for clinical use for multiple heart conditions in Canada and Europe and continues to be available for investigational use only in the United States.
- November 17, 2013
- Platelet Genetic Variation by Race Has Implications for Personalized Medicine
Platelet expression of a protein that affects thrombin receptors is enhanced in blacks, compared with whites, and potentially explains some race-related variation in platelet activation and, by extension, thrombus-mediated ischemic risk, suggests a laboratory study published in Nature Medicine.
- Inhaled Corticosteroids in COPD and the Risk of Serious Pneumonia
Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use.
- November 16, 2013
- Many NHLBI-Funded Trials Never Published, Prompting Funding Rethink
A new analysis undertaken by researchers at the National Heart, Lung, and Blood Institute (NHLBI) indicates that more than one-third of the cardiovascular disease studies funded by the institute over an 11-year period remain unpublished within 30 months of their completion, with many never making their way to print. But of note, write Dr David Gordon and colleagues, of the NHLBI-funded trials that were designed to have hard clinical end points—the minority of NHLBI-funded research—more than 95% were published within 30 months.
- Accelerate Optimal Air Pressure Settings for Sleep Apnea
Fixed air pressure can be optimized for 97% of patients with obstructive sleep apnea in as few as 4 days, according to the results of a new study. This compares favorably with the 7 days typically used to determine optimal continuous positive airway pressure (CPAP) treatment settings.
- November 15, 2013
- Health Canada approves OPSUMIT for the treatment of PAH
Actelion Pharmaceuticals Canada Inc. announced today that Health Canada has approved the oral endothelin receptor antagonist OPSUMIT (macitentan) 10mg once daily for the long term treatment of pulmonary arterial hypertension (PAH) to reduce morbidity.
- New gene therapy could reverse heart failure in pigs: study
(Global Times, China)
US researchers said Wednesday they have successfully tested a powerful gene therapy, delivered directly into the heart, to reverse heart failure in pigs...
- November 14, 2013
- New research devises effective way to evaluate severity of pulmonary hypertension
New research led by Professor Norm Morris from the Griffith Health Institute’s Heart Foundation Research Centre has devised a simple, but effective way of evaluating the severity of pulmonary hypertension during exercise which may assist in the diagnosis and long-term management of this condition.
By adding simple measurements of gas exchange to a standard clinical outcome measure, the Six Minute Walk Test, Professor Morris has shown it is able to better predict disease severity in patients with pulmonary hypertension...
- November 12, 2013
- “Who’ll be the next in line?” The lung allocation score in patients with pulmonary arterial hypertension
(Journal of Heart Lung Transplantation)
Click headline to access the editorial