RESUMEN
There is considerable ongoing investment in the research and development of selective progesterone receptor (PR) modulators for the treatment of gynecological conditions such as endometriosis. Here, we provide the first report on the clinical evaluation of a nonsteroidal progesterone receptor antagonist 4-[3-cyclopropyl-1-(mesylmethyl)-5-methyl-1H-pyrazol-4-yl]oxy,-2,6-dimethylbenzonitrile (PF-02413873) in healthy female subjects. In in vitro assays, PF-02413873 behaved as a selective and fully competitive PR antagonist, blocking progesterone binding and PR nuclear translocation. The pharmacological mode of action of PF-02413873 seems to differ from the founding member of the class of steroidal PR antagonists, 11ß-4-dimethylaminophenyl-17ß-hydroxy-17α-propinyl-4,9-estradiene-3-one (RU-486; mifepristone). Exposure-effect data from studies in the cynomolgus macaque, however, demonstrated that PF-02413873 reduced endometrial functionalis thickness to a comparable degree to RU-486 and this effect was accompanied by a decrease in proliferation rate (as measured by bromodeoxyuridine incorporation) for both RU-486 and high-dose PF-02413873. These data were used to underwrite a clinical assessment of PF-02413873 in a randomized, double-blinded, third-party open, placebo-controlled, dose-escalation study in healthy female volunteers with dosing for 14 days. PF-02413873 blocked the follicular phase increase in endometrial thickness, the midcycle lutenizing hormone surge, and elevation in estradiol in a dose-dependent fashion compared with placebo. This is the first report of translational efficacy data with a nonsteroidal PR antagonist in cynomolgus macaque and human subjects.
Asunto(s)
Endometrio/efectos de los fármacos , Estrógenos no Esteroides/farmacología , Fase Folicular/efectos de los fármacos , Pirazoles/farmacología , Receptores de Progesterona/antagonistas & inhibidores , Sulfonas/farmacología , Adulto , Animales , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Endometriosis/tratamiento farmacológico , Estradiol/sangre , Femenino , Antagonistas de Hormonas/farmacología , Humanos , Hormona Luteinizante/sangre , Macaca , Mifepristona/farmacología , Terapia Molecular Dirigida , Investigación Biomédica Traslacional , Adulto JovenRESUMEN
The anorectic drug, dexfenfluramine has been associated with an increase in the relative risk of developing pulmonary hypertension. 5-hydroxytryptamine (5-HT) is a mitogen for smooth muscle cell, an effect that relies on 5-HT transporter expression and which has been proposed to explain pulmonary side effect of dexfenfluramine, and more particularly its effect on vascular remodeling. However recent data supported a major role of pulmonary artery vasoconstriction through the RhoA/Rho-kinase pathway. We questioned whether or not anorectic treatment aggravates pulmonary hypertension through vascular remodeling and if RhoA/Rho-kinase (ROCK) was potentially involved. In rats exposed to hypoxia, concomitant dexfenfluramine treatment (5 mg/kg/day, i.v.) for 4 weeks had no effect on pulmonary hypertension development. When exposure to 2 weeks of chronic hypoxia followed discontinuation of dexfenfluramine treatment (dexfenfluramine-hypoxic rats), echocardiographic parameters of pulmonary artery flow and right ventricle were further altered (P<0.05) as well as right ventricle systolic pressure was further increased (P<0.001) when compared to hypoxic rats treated with vehicle (hypoxic rats). However, the total number of muscularized distal pulmonary arteries artery was similar in dexfenfluramine-hypoxic vs. hypoxic rats (P>0.05). Western blot, RT-PCR and immunofluorescence analysis revealed a greater expression of 5-HT transporter and ROCK, as well as a greater activation of RhoA in dexfenfluramine-hypoxic rats compared to hypoxic rats. These data show that increased 5-HT transporter expression that follows dexfenfluramine discontinuation is not associated to a greater vascular remodeling despite worsening the development of pulmonary hypertension. Furthermore dexfenfluramine discontinuation promotes a greater RhoA/ROCK pathway activation. This pathway, involved in many cardiovascular diseases, might explain the cardiac and pulmonary toxicity of serotoninergic agonists.
Asunto(s)
Dexfenfluramina/efectos adversos , Hipertensión Pulmonar/etiología , Hipoxia/complicaciones , Pulmón/fisiopatología , Transducción de Señal/efectos de los fármacos , Quinasas Asociadas a rho/metabolismo , Proteína de Unión al GTP rhoA/metabolismo , Animales , Depresores del Apetito/efectos adversos , Activación Enzimática/efectos de los fármacos , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Hipertensión Pulmonar/metabolismo , Hipertensión Pulmonar/fisiopatología , Hipertrofia Ventricular Derecha/metabolismo , Hipertrofia Ventricular Derecha/fisiopatología , Pulmón/irrigación sanguínea , Pulmón/patología , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Aumento de Peso/efectos de los fármacos , Quinasas Asociadas a rho/genética , Proteína de Unión al GTP rhoA/genéticaRESUMEN
Historically, histopathology evaluation is performed by a pathologist generating a qualitative assessment on thin tissue sections on glass slides. In the past decade, there has been a growing interest for tools able to reduce human subjectivity and improve workload. Whole slide scanning technology combined with object orientated image analysis can offer the capacity of generating fast and reliable results. In the present study, we combined the use of these emerging technologies to characterise a mouse model for chronic asthma. We monitored the inflammatory changes over five weeks by measuring the number of neutrophils and eosinophils present in the tissue, as well as, the bronchiolar associated lymphoid tissue (BALT) area on whole lungs sections. We showed that inflammation assessment could be automated efficiently and reliably. In comparison to human evaluation performed on the same set of sections, computer generated data was more descriptive and fully quantitative. Moreover optimisation of our detection parameters allowed us to be to more sensitive and to generate data in a larger dynamic range to traditional experimental evaluation, such as bronchiolar lavage (BAL) inflammatory cell counts obtained by flow cytometry. We also took advantage of the fact that we could increase the number of samples to be analysed within a day. Such optimisation allowed us to determine the best study design and experimental conditions in order to increase statistical significance between groups. In conclusion, we showed that combination of whole slide digital scanning and image analysis could be fully automated and deliver more descriptive and biologically relevant data over traditional methods evaluating histopathological pulmonary changes observed in this mouse model of chronic asthma.