A non-human primate model for investigating drug-induced risk of orthostatic hypotension and sympathetic dysfunction: Preclinical correlate to a clinical test.

INTRODUCTION: Drug induced orthostatic hypotension (OH) is an important clinical concern and can be an unexpected hurdle during drug development. OH is defined as an abnormal decrease in blood pressure (BP) triggered by a rapid postural change. The sympathetic nervous system is critical for controlling normal cardiovascular function and compensatory responses to changes in posture. Thus, OH can also serve as a surrogate indicator of sympathetic dysfunction. However, preclinical conscious models for investigating risk of OH and/or sympathetic dysfunction are lacking. Herein, we describe a conscious nonhuman primate (NHP) model which mimics the widely used clinical tilt table test for OH. METHODS: Male, Cynomolgus NHPs (n = 7-8) implanted with radio-telemetry transmitters were placed in modified tilt chairs in a supine position. Subsequently, a 90° head up tilt was performed for 3 min followed by return to the supine position. BP and heart rate were continuously monitored. Test compounds were administered either intravenously or via oral gavage in a crossover design, with blood samples collected at the end of the each tilt to assess total drug concentrations. RESULTS: Tilt responses were assessed following treatment with positive control compounds that cause sympathetic dysfunction; hexamethonium (ganglionic blocker) and prazosin (alpha-1 adrenergic receptor antagonist). Both compounds induced marked OH as evidenced by robust and sustained BP reduction in response to a head up tilt (decrease of 25-35 mmHg for hexamethonium, decrease of 21-44 mmHg for prazosin). OH incidence rates increased in a dose-dependent manner. OH incidences following treatment with minoxidil (vasodilator) were markedly lower to those observed with hexamethonium and prazosin indicating the role of sympathetic dysfunction in causing OH. DISCUSSION: These data demonstrate that the NHP tilt test is a valuable model for investigating OH risk. This model fills an important preclinical gap for assessing such a safety concern and can be applied to programs where a sympathetic deficit and/or OH are anticipated or clinically observed.

Cardiovascular effects of an organophosphate toxin isolated from Ptychodiscus brevis.

The dose-dependent hypotensive and bradycardic effects induced by an ichthyotoxic organophosphate compound isolated from the marine dinoflagellate Ptychodiscus brevis were studied. These effects were not antagonized by atropine, but potentiated by alpha-adrenoceptor blocker and hexamethonium. The toxin abolished the vasopressor effect elicited by phenylephrine, indicating an alpha-adrenergic blocking activity. The cardiovascular depressor responses were antagonized by tetraethylammonium while blockade of cholinergic and histaminergic receptors or inhibition of prostaglandin synthesis failed to modify these effects. The results indicate that the cardiovascular depressor effects of the toxin are probably mediated through alpha-adrenergic and ganglionic blockade accompanied by modulation of potassium channel activity.

Hindquarter vascular resistance as compensator for hypotension in conscious rats.

The purpose of this study was to test whether hindquarter (terminal aortic) vascular resistance uniquely increases in order to compensate for interventions which result in a lowering of arterial pressure. Changes in hindquarter resistance were compared to changes in superior mesenteric resistance after the administration of the nitrovasodilator drug, molsidomine. Hindquarter blood flow or superior mesenteric flow was measured in conscious rats using an electromagnetic flow probe implanted around the terminal aorta or the superior mesenteric artery, respectively. Twenty minutes after an intravenous bolus injection of molsidomine (1 mg/kg), ganglionic blockade with hexamethonium bromide (25 mg/kg, i.v.) significantly decreased hindquarter resistance, but not superior mesenteric resistance. In the absence of molsidomine, ganglionic blockade has no effect on resistance in either vascular bed. These findings suggest that excitation of sympathetic vasoconstrictor fibers supplying the hindquarters but not those supplying the superior mesenteric area occurred in response to the hypotensive effect of molsidomine. This is consistent with the hypothesis that augmenting-hindquarter resistance is the first line of defense against hypotensive interventions.