Targeted therapies in pulmonary arterial hypertension

David Montani; Marie-Camille Chaumais; Christophe Guignabert; Sven Günther; Barbara Girerd; Xavier Jaïs; Vincent Algalarrondo; Laura C Price; Laurent Savale; Olivier Sitbon; Gérald Simonneau; Marc Humbert

doi:10.1016/j.pharmthera.2013.10.002

Targeted therapies in pulmonary arterial hypertension

Pharmacol Ther. 2014 Feb;141(2):172-91. doi: 10.1016/j.pharmthera.2013.10.002. Epub 2013 Oct 14.

Affiliations

¹ Univ. Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
² INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France; Univ. Paris-Sud, Châtenay Malabry, France; AP-HP, Pharmacie, DHU Thorax Innovation, Hôpital Antoine Béclère, Clamart, France.
³ Univ. Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Cardiologie, DHU Thorax Innovation, Hôpital Antoine Béclère, Clamart, France.
⁴ National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Dovehouse Street, London SW3 6LY, UK.
⁵ Univ. Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. Electronic address: marc.humbert@bct.aphp.fr.

PMID: 24134901
DOI: 10.1016/j.pharmthera.2013.10.002

Abstract

Pulmonary arterial hypertension (PAH) is a rare disorder characterized by progressive obliteration of small pulmonary arteries that leads to elevated pulmonary arterial pressure and right heart failure. During the last decades, an improved understanding of the pathophysiology of the disease has resulted in the development of effective therapies targeting endothelial dysfunction (epoprostenol and derivatives, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors). These drugs allow clinical, functional and hemodynamic improvement. Even though, no cure exists for PAH and prognosis remains poor. Recently, several additional pathways have been suggested to be involved in the pathogenesis of PAH, and may represent innovative therapies. In this summary, we review conventional therapy, pharmacological agents currently available for the treatment of PAH and the benefit/risk ratio of potential future therapies.

Keywords: ACVRL1; BMPR2; CCB; CO; CYP; EC; EGF; ENG; ERA; ET; Endothelial dysfunction; Endothelin receptor antagonist; FGF2; IPr; Kinase inhibitors; Kv; LVEF; MCT; NYHA; New York Heart Association; OS; PAH; PASMC; PDE-5; PDGF; PGI2; PGI2 receptor; PH; PVR; Prostacyclin; Pulmonary arterial hypertension; ROCK; ROS; RTK; RhoA/Rho kinase; SMC; SOD; TGF; TKI; TXA2; Type 5 phosphodiesterase inhibitors; VIP; VPAC; activin A receptor type II-like kinase-1; bone morphogenetic protein receptor type 2; cAMP; cGMP; calcium channel blockers; cardiac output; cyclic adenosine monophosphate; cyclic guanosine monophosphate; cytochrome P450; endoglin; endothelial cell; endothelin; endothelin receptor antagonist; epidermal growth factor; fibroblast growth factor 2; iPAH; idiopathic PAH; left ventricular ejection fraction; mPAP; mean pulmonary arterial pressure; monocrotaline; oxidative stress; phosphodiesterase type 5; platelet-derived growth factor; prostacyclin; pulmonary arterial hypertension; pulmonary artery smooth muscle cells; pulmonary hypertension; pulmonary vascular resistance; reactive oxygen species; receptor tyrosine kinase; sGc; smooth muscle cell; soluble guanylate cyclase; superoxide dismutase; thromboxane; transforming growth factor; tyrosine kinase inhibitor; vasoactive intestinal polypeptide; vasoactive intestinal polypeptide receptor; voltage-gated potassium channels.

Publication types

Review

MeSH terms

Animals
Familial Primary Pulmonary Hypertension
Humans
Hypertension, Pulmonary / drug therapy*
Hypertension, Pulmonary / metabolism
Hypertension, Pulmonary / physiopathology