Discovery of a potent and selective ROMK inhibitor with improved pharmacokinetic properties based on an octahydropyrazino[2,1-c][1,4]oxazine scaffold.

Following the discovery of small molecule acyl piperazine ROMK inhibitors, the acyl octahydropyrazino[2,1-c][1,4]oxazine series was identified. This series displays improved ROMK/hERG selectivity, and as a consequence, the resulting ROMK inhibitors do not evoke QTc prolongation in an in vivo cardiovascular dog model. Further efforts in this series led to the discovery of analogs with improved pharmacokinetic profiles. This new series also retained comparable ROMK potency compared to earlier leads.

Discovery of MK-7145, an Oral Small Molecule ROMK Inhibitor for the Treatment of Hypertension and Heart Failure.

ROMK, the renal outer medullary potassium channel, is involved in potassium recycling at the thick ascending loop of Henle and potassium secretion at the cortical collecting duct in the kidney nephron. Because of this dual site of action, selective inhibitors of ROMK are expected to represent a new class of diuretics/natriuretics with superior efficacy and reduced urinary loss of potassium compared to standard-of-care loop and thiazide diuretics. Following our earlier work, this communication will detail subsequent medicinal chemistry endeavors to further improve lead selectivity against the hERG channel and preclinical pharmacokinetic properties. Pharmacological assessment of highlighted inhibitors will be described, including pharmacodynamic studies in both an acute rat diuresis/natriuresis model and a subchronic blood pressure model in spontaneous hypertensive rats. These proof-of-biology studies established for the first time that the human and rodent genetics accurately predict the in vivo pharmacology of ROMK inhibitors and supported identification of the first small molecule ROMK inhibitor clinical candidate, MK-7145.

Differentiation of ROMK potency from hERG potency in the phenacetyl piperazine series through heterocycle incorporation.

Following the discovery of small molecule acyl piperazine ROMK inhibitors and their initial preclinical validation as a novel diuretic agent, our group set out to discover new ROMK inhibitors with reduced risk for QT effects, suitable for further pharmacological experiments in additional species. Several strategies for decreasing hERG affinity while maintaining ROMK inhibition were investigated and are described herein. The most promising candidate, derived from the newly discovered 4-N-heteroaryl acetyl series, improved functional hERG/ROMK ratio by >10× over the previous lead. In vivo evaluation demonstrated comparable diuretic effects in rat with no detectable QT effects at the doses evaluated in an in vivo dog model.

Discovery of a Potent and Selective ROMK Inhibitor with Pharmacokinetic Properties Suitable for Preclinical Evaluation.

A new subseries of ROMK inhibitors exemplified by 28 has been developed from the initial screening hit 1. The excellent selectivity for ROMK inhibition over related ion channels and pharmacokinetic properties across preclinical species support further preclinical evaluation of 28 as a new mechanism diuretic. Robust pharmacodynamic effects in both SD rats and dogs have been demonstrated.

Pharmacologic inhibition of the renal outer medullary potassium channel causes diuresis and natriuresis in the absence of kaliuresis.

The renal outer medullary potassium (ROMK) channel, which is located at the apical membrane of epithelial cells lining the thick ascending loop of Henle and cortical collecting duct, plays an important role in kidney physiology by regulating salt reabsorption. Loss-of-function mutations in the human ROMK channel are associated with antenatal type II Bartter's syndrome, an autosomal recessive life-threatening salt-wasting disorder with mild hypokalemia. Similar observations have been reported from studies with ROMK knockout mice and rats. It is noteworthy that heterozygous carriers of Kir1.1 mutations associated with antenatal Bartter's syndrome have reduced blood pressure and a decreased risk of developing hypertension by age 60. Although selective ROMK inhibitors would be expected to represent a new class of diuretics, this hypothesis has not been pharmacologically tested. Compound A [5-(2-(4-(2-(4-(1H-tetrazol-1-yl)phenyl)acetyl)piperazin-1-yl)ethyl)isobenzofuran-1(3H)-one)], a potent ROMK inhibitor with appropriate selectivity and characteristics for in vivo testing, has been identified. Compound A accesses the channel through the cytoplasmic side and binds to residues lining the pore within the transmembrane region below the selectivity filter. In normotensive rats and dogs, short-term oral administration of compound A caused concentration-dependent diuresis and natriuresis that were comparable to hydrochlorothiazide. Unlike hydrochlorothiazide, however, compound A did not cause any significant urinary potassium losses or changes in plasma electrolyte levels. These data indicate that pharmacologic inhibition of ROMK has the potential for affording diuretic/natriuretic efficacy similar to that of clinically used diuretics but without the dose-limiting hypokalemia associated with the use of loop and thiazide-like diuretics.

Discovery of a novel sub-class of ROMK channel inhibitors typified by 5-(2-(4-(2-(4-(1H-Tetrazol-1-yl)phenyl)acetyl)piperazin-1-yl)ethyl)isobenzofuran-1(3H)-one.

A sub-class of distinct small molecule ROMK inhibitors were developed from the original lead 1. Medicinal chemistry endeavors led to novel ROMK inhibitors with good ROMK functional potency and improved hERG selectivity. Two of the described ROMK inhibitors were characterized for the first in vivo proof-of-concept biology studies, and results from an acute rat diuresis model confirmed the hypothesis that ROMK inhibitors represent new mechanism diuretic and natriuretic agents.

Heterozygous disruption of renal outer medullary potassium channel in rats is associated with reduced blood pressure.

The renal outer medullary potassium channel (ROMK, KCNJ1) mediates potassium recycling and facilitates sodium reabsorption through the Na(+)/K(+)/2Cl(-) cotransporter in the loop of Henle and potassium secretion at the cortical collecting duct. Human genetic studies indicate that ROMK homozygous loss-of-function mutations cause type II Bartter syndrome, featuring polyuria, renal salt wasting, and hypotension; humans heterozygous for ROMK mutations identified in the Framingham Heart Study have reduced blood pressure. ROMK null mice recapitulate many of the features of type II Bartter syndrome. We have generated an ROMK knockout rat model in Dahl salt-sensitive background by using zinc finger nuclease technology and investigated the effects of knocking out ROMK on systemic and renal hemodynamics and kidney histology in the Dahl salt-sensitive rats. The ROMK(-/-) pups recapitulated features identified in the ROMK null mice. The ROMK(+/-) rats, when challenged with a 4% salt diet, exhibited a reduced blood pressure compared with their ROMK(+/+) littermates. More importantly, when challenged with an 8% salt diet, the Dahl salt-sensitive rats with 50% less ROMK expression showed increased protection from salt-induced blood pressure elevation and signs of protection from renal injury. Our findings in ROMK knockout Dahl salt-sensitive rats, together with the previous reports in humans and mice, underscore a critical role of ROMK in blood pressure regulation.

Metabolic syndrome in mice induced by expressing a transcriptional activator in adipose tissue.

Metabolic syndrome is a combination of medical disorders that increases the risk of developing cardiovascular disease and diabetes. Constitutive overexpression of 11ß-HSD1 in adipose tissue in mice leads to metabolic syndrome. In the process of generating transgenic mice overexpressing 11ß-HSD1 in an inducible manner, we found a metabolic syndrome phenotype in control, transgenic mice, expressing the reverse tetracycline-transactivator (rtTA) in adipose tissue. The control mice exhibited all four sequelae of metabolic syndrome (visceral obesity, insulin resistance, dyslipidemia, and hypertension), a pro-inflammatory state and marked hepatic steatosis. Gene expression profiling of the adipose tissue, muscle and liver of these mice revealed changes in expression of genes involved in lipid metabolism, insulin resistance, and inflammation. Transient transfection of rtTA, but not tTS, into 3T3-L1 cells resulted in lipid accumulation. We conclude that expression of rtTA in adipose tissue causes metabolic syndrome in mice.

Prevalence and correlates of elder mistreatment in South Carolina: the South Carolina elder mistreatment study.

The purposes of this study were to (a) derive prevalence estimates for elder mistreatment (emotional, physical, sexual, neglectful, and financial mistreatment of older adults [age 60 +]) in a randomly selected sample of South Carolinians; (b) examine correlates (i.e., potential risk factors) of mistreatment; and (c) examine incident characteristics of mistreatment events. Random Digit Dialing (RDD) was used to derive a representative sample in terms of age and gender; computer-assisted telephone interviewing was used to standardize collection of demographic, correlate, and mistreatment data. Prevalence estimates and mistreatment correlates were obtained and subjected to logistic regression. A total of 902 participants provided data. Prevalence for mistreatment types (since age 60) were 12.9% emotional, 2.1% physical, 0.3% sexual, 5.4% potential neglect, and 6.6% financial exploitation by family member. The most consistent correlates of mistreatment across abuse types were low social support and needing assistance with daily living activities. One in 10 participants reported either emotional, physical, sexual, or neglectful mistreatment within the past year, and 2 in 10 reported mistreatment since age 60. Across categories, the most consistent correlate of mistreatment was low social support, representing an area toward which preventive intervention may be directed with significant public health implications.

Do incident and perpetrator characteristics of elder mistreatment differ by gender of the victim? Results from the National Elder Mistreatment Study.

Perpetrator and incident characteristics were studied in regard to incidents of emotional, physical, and sexual mistreatment of older adults (age 60+) in a national sample of older men and women. Random digit dialing across geographic strata was used to compile a nationally representative sample; computer assisted telephone interviewing was used to standardize collection of demographic, mistreatment, and perpetrator and incident characteristics data. The final sample size consisted of 5,777 older adults. Approximately one in ten adults reported at least one form of mistreatment, and the majority of incidents were not reported to authorities. Perpetrators of physical mistreatment against men had more "pathological" characteristics compared to perpetrators of physical mistreatment against women. Perpetrators of physical mistreatment (compared to emotional and sexual mistreatment) also evidenced increased likelihood of legal problems, psychological treatment, substance use during incident, living with the victim, and being related to the victim. Implications for future research and social policy are discussed.

Elder mistreatment and emotional symptoms among older adults in a largely rural population: the South Carolina elder mistreatment study.

Although two recent major studies provide some insight into the prevalence and correlates of elder mistreatment, the relationship between elder mistreatment and mental health remains unclear. This study begins to address this issue by examining the relationship between elder mistreatment (i.e., a recent history of emotional and physical abuse) and negative emotional symptoms (e.g., anxiety and depression) among 902 older adults aged 60 and above residing in South Carolina. Results demonstrate that emotional, but not physical, abuse is significantly correlated with higher levels of emotional symptoms. This relationship is sustained when controlling for established demographic and social/dependency risk factors. These data suggest that mistreated older adults also suffer from greater emotional symptoms and highlight the need for more research in this area.

Elder mistreatment and physical health among older adults: the South Carolina Elder Mistreatment Study.

Exposure to potentially traumatic events (PTEs), including interpersonal violence, is associated with poorer physical health in young adults. This relation has not been well-investigated among older adults in specific populations. The present study was designed to investigate whether exposure to PTEs and elder mistreatment are associated with physical health status among older adults residing in South Carolina. Older adults aged 60 and above (N = 902) participated in a structured interview assessing elder mistreatment history, PTEs, demographics, and social dependency variables. Results demonstrated that PTEs were associated with poor self-rated health independently and when controlling for other significant predictors. A recent history of emotional mistreatment was associated with poor self-rated health independently, but not when controlling for other significant predictors.

Prevalence and correlates of poor self-rated health in the United States: the national elder mistreatment study.

OBJECTIVES: Despite its subjective nature, self-report of health status is strongly correlated with long-term physical morbidity and mortality. Among the most reliable predictors of self-reported poor health is older age. In younger adult populations, the second reliable predictor of reported poor health is the experience of domestic and other interpersonal violence. However, very little research exits on the connection between elder mistreatment and self-reports of poor health. The aim of this study was to examine the level of, and correlates for, poor self-rated health in a community sample of older adults with particular emphasis on elder mistreatment history, demographics, and social dependency variables. DESIGN: Random digit dialing telephone survey methodology. SETTING: A national representative phone survey of noninstitutionalized U.S. household population. PARTICIPANTS: Five thousand seven hundred seventy-seven U.S. adults, aged 60 years and older. MEASUREMENTS: Individuals participated in a structured interview assessing elder mistreatment history, demographics, and social dependency variables. RESULTS: Poor self-rated health was endorsed by 22.3% of the sample. Final multivariable logistic regression models showed that poor self-rated health was associated with unemployment, marital status, low income, low social support, use of social services, needing help in activities of daily living, and being bothered by emotional problems. Secondary analyses revealed a mediational role of emotional symptoms in the association between physical maltreatment and poor health. CONCLUSIONS: Results suggest that poor health is common among older adults. This study also identified correlates of poor health that may be useful in identification of those in need of intervention.

Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study.

OBJECTIVES: We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample. METHODS: We compiled a representative sample by random digit dialing across geographic strata. We used computer-assisted telephone interviewing to standardize collection of demographic, risk factor, and mistreatment data. We subjected prevalence estimates and mistreatment correlates to logistic regression. RESULTS: We analyzed data from 5777 respondents. One-year prevalence was 4.6% for emotional abuse, 1.6% for physical abuse, 0.6% for sexual abuse, 5.1% for potential neglect, and 5.2% for current financial abuse by a family member. One in 10 respondents reported emotional, physical, or sexual mistreatment or potential neglect in the past year. The most consistent correlates of mistreatment across abuse types were low social support and previous traumatic event exposure. CONCLUSIONS: Our data showed that abuse of the elderly is prevalent. Addressing low social support with preventive interventions could have significant public health implications.

Respuestas psicofisiológicas y cognitivas ante situaciones estresantes en estudiantes de la Universidad Simón Bolívar / Psychophysiological and cognitive responses to stressful situations in students of the Universidad Simón Bolívar

En esta investigación se midió la respuesta cardiovascular al estrés, autoeficacia computacional y la percepción de dificultad de la tarea, en una muestra de 115 estudiantes de pregrado de la Universidad Simón Bolívar. Los resultados evidencian que en cuanto a los parámetros fisiológicos cardiovasculares, hubo elevación en la presión arterial y la frecuencia cardíaca en ambas versiones del test de stroop (clásico y computarizado). En general, la percepción de la dificultad de la tarea en estos sujetos fue más elevada ante el stroop clásico. Finalmente, en relación con la autoeficacia computacional los sujetos presentan valores altos, lo cual indica una percepción de habilidades para trabajar frente a un computador. Estos resultados representan una contribución importante, pues están indicando la relación de las variables cognitivas y las respuestas fisiológicas del estudiante universitario ante situaciones demandantes o difíciles. De esta manera, las situaciones vividas en el ambiente académico pueden tener un impacto relevante en los estados de salud, y debemos tomar en consideración estos aspectos para el beneficio integral del estudiante

In this investigation of the Cardiovascular Response to Stress, Perceived Task Difficulty and physiological responding were measured. The study used a sample of 115 undergraduate students of a Simon Bolivar University. Results show that a great elevation of heart rate and blood pressure was observed during exposure to the two versions of the Stroop Test (classical and computerized). In general, ratings of perceived difficulty of the Stroop task were higher in response to the Classical administration. Finally, subjects rated their Computer Self-Efficacy as high, indicating confidence and comfort working with computers. These results represent an important contribution that illustrate the relation of cognitive factors to physiological responses during cognitively demanding or difficult situations. In terms of the practical implications of these findings, situations experienced in academic environments can have a prominent impact in cardiovascular responding, and thus, health. As such, it is indicating that the medium of academic assessment might be an appropriate target for change in some settings for the benefit of the Student

Respuesta cardiovascular al estrés, autoeficacia computacional y percepción de dificultad de la tarea en estudiantes universitarios venezolano / Cardiovascular response to stress, computational self-efficacy and perceived task difficulty in undergraduate Venezuelan students

Este estudio evaluó la respuesta cardiovascular al estrés en el laboratorio, la autoeficacia computacional y la percepción de dificultad de la tarea en 115 estudiantes de la Universidad Simón Bolívar (Venezuela). Los resultados evidencian que la presión arterial sistólica tiende a valores altos ante el Stroop clásico; mientras que la presión arterial diastólica, en ambas versiones del “test de Stroop” (clásico y computarizado), se distribuyó en valores bajos-medios. Se observa una mayor elevación de la frecuencia cardíaca ante el Stroop clásico. En general, la percepción de la dificultad de la tarea en estos sujetos fue más elevada ante el Stroop clásico. Finalmente, en relación con la autoeficacia computacional los sujetos presentan valores altos. Estos resultados representan una contribución importante, ya que son indicativos de la relación de las variables cognitivas y las respuestas fisiológicas del estudiante universitario ante situaciones demandantes o difíciles. De esta manera, las situaciones vividas en el ambiente académico pueden tener un impacto relevante en los estados de salud y debemos tomar en consideración estos aspectos para el beneficio integral del estudiante (AU)

This paper evaluated the cardiovascular response to stress in a laboratory situation, the computational self-efficacy, and the perceived difficulty of the task, in a sample of 115 undergraduate students of Simon Bolivar University. Results show that the sample distribution of systolic blood pressure (SBP) has a tendency to high values in the classical Stroop task; while the diastolic blood pressure (DBP) obtained in response to both versions of Stroop Test (classical and computerized) was in the low to medium values of the variable, with noticeable elevations during the Stroop tasks. A greater increase of heart rate (HR) was observed during exposure to the Classically administered version of the Stroop task. In general, ratings of perceived difficulty of the Stroop task were higher in response to the Classical administration. Finally, subjects rated their Computer Self-Efficacy as high, indicating confidence and comfort working with computers. These results represent an important contribution to the stress and coping literature as they illustrate the relationship between cognitive factors and physiological responses during cognitively demanding or difficult situations. In terms of the practical implications of these findings, situations experienced in academic environments can have a prominent impact on cardiovascular response, and thus, on health

Trastorno por estrés postraumático en niños: una revisión / Posttraumatic stress disorder in children: a review

La psicología clínica infantil se ha orientado cada vez más hacia cómo evaluar la ocurrencia e impacto de eventos traumáticos en niños, con el propósito específico de desarrollar técnicas terapéuticas eficaces y eficientes para ayudarles a manejar las secuelas de tales eventos. Este trabajo es una revisión general de la literatura psicológica sobre el trauma en la infancia. Nos centramos en asuntos de importancia para los clínicos que trabajan directamente con estos niños y sus familias, tales como: ¿cuántos niños experimentan eventos traumáticos?, ¿cuáles son los tipos de trauma que experimentan con más frecuencia?, ¿cómo deberían ser evaluados el trauma infantil y sus consecuencias en la práctica clínica?, ¿cuáles son las intervenciones terapéuticas disponibles?, ¿qué información se requiere y cuáles son los retos que hay que afrontar? A lo largo de este trabajo, consideraremos factores biológicos, individuales y culturales y prestaremos particular atención a cómo las innovaciones en la tecnología y la comunicación son una promesa en este campo (AU)

The field of child clinical psychology has increasingly focused on how to assess the occurrence and impact of traumatic events on children with the explicit goal of determining effective and efficient therapeutic techniques for helping children manage the sequelae of such events. This paper provides an overview of the psychological literature in childhood trauma. We address important questions most pertinent to clinicians working with children and families: How many children experience traumatic events? What types of trauma do children most often experience? How should childhood trauma and related outcomes be assessed in clinical practice? What therapeutic interventions are available? What information is yet needed and what challenges do we face? Throughout, we consider biological, individual, and cultural factors and pay particular attention to how innovations in technology and communications hold promise for this field

Phenolic acids suppress adipocyte lipolysis via activation of the nicotinic acid receptor GPR109A (HM74a/PUMA-G).

Phenolic acids are found in abundance throughout the plant kingdom. Consumption of wine or other rich sources of phenolic acids, such as the "Mediterranean diet," has been associated with a lower risk of cardiovascular disease. The underlying mechanism(s), however, has remained unclear. Here, we show that many phenolic acids, including those from the hydroxybenzoic and hydroxycinnamic acid classes, can bind and activate GPR109A (HM74a/PUMA-G), the receptor for the antidyslipidemic agent nicotinic acid. In keeping with this activity, treatment with a number of phenolic acids, including cinnamic acid, reduces lipolysis in cultured human adipocytes and in fat pats isolated from wild-type mice but not from mice deficient of GPR109A. Oral administration of cinnamic acid significantly reduces plasma levels of FFA in the wild type but not in mice deficient of GPR109A. Activation of GPR109A by phenolic acids may thus contribute to a cardiovascular benefit of these plant-derived products.

Critical role of cholesterol ester transfer protein in nicotinic acid-mediated HDL elevation in mice.

Nicotinic acid is a commonly used anti-dyslipidemic agent that increases plasma levels of HDL-cholesterol and decrease triglycerides (TG), and VLDL- and LDL-cholesterol. The most well-studied effect of nicotinic acid is its ability to lower plasma free fatty acids, which has been observed in humans and many animal models. However, its ability to raise HDL in humans has not been replicated in animal models, which precludes studying the mechanism of HDL elevation. Here we studied lipid-modulating effects of nicotinic acid in mice carrying genomic DNA fragments that drive expression of various human genes in the mouse liver. Treatment with nicotinic acid reduced serum levels of HDL cholesterol in wild-type and human apolipoprotein B100 (apoB100)-transgenic mice. In contrast, nicotinic acid treatment of mice that express human cholesteryl ester transfer protein (CETP), with or without concomitant apoB100 expression, resulted in a significant increase of HDL cholesterol and reduction of TG, VLDL- and LDL-cholesterol. These data demonstrate a critical role of CETP in nicotinic acid-mediated HDL elevation, and suggest that mice carrying the human CETP gene may be useful animal models for studying the HDL-elevating effect of nicotinic acid.

Factores de riesgo y protectores de enfermedades cardiovasculares en población estudiantil universitaria / Risk factors and crdiovascular disease protectors in students university population

Se estudió la presencia de factores de riesgo y protectores para enfermedades cardiovasculares, en universitarios jóvenes normotensos. La muestra estuvo comprendida por 100 sujetos, 39 mujeres y 61 hombres, estudiantes voluntarios de las carreras de pregrado de la Universidad Simón Bolívar. Es un estudio no experimental, de campo y transversal. Los instrumentos utilizados para la recolección de datos fueron: Dinamap, cuestionario de ansiedad de Spielberger, y cuestionario de información personal. Los resultados obtenidos sugieren que los estudiantes universitarios presentan síntomas de ansiedad lo que indica un manejo inadecuado del estrés académico y desconocimiento de los antecedentes familiares paternos y maternos. Sólo el 22 por ciento reconoce llevar una dieta balanceada. Sin embargo, muestran conductas protectoras. El 77 por ciento no fuma, y el 85 por ciento realiza algún tipo de ejercicio. Existen variables como la ansiedad, la dieta no balanceada y el desconocimiento de antecedentes familiares que deben ser manejados por los profesionales de la salud para ayudar a estos jóvenes en el manejo del estrés y la consecución de estilos de vida saludables para la prevención de enfermedades cardiovasculares.