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Meeting Abstracts from the 9Th International Conference on Cgmp: Generators, Efectors and Therapeutic Implications

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Meeting Abstracts from the 9Th International Conference on Cgmp: Generators, Efectors and Therapeutic Implications J Transl Med 2019, 17(Suppl 2):254 https://doi.org/10.1186/s12967-019-1994-0 Journal of Translational Medicine MEETING ABSTRACTS Open Access Meeting abstracts from the 9th International Conference on cGMP: Generators, Efectors and Therapeutic Implications Germany. 14–16 June 2019 Published: 15 August 2019 S 1‑01 References NO‑sGC signaling and therapeutics in sickle cell and hemolytic 1. Ataga KI, Moore CG, Jones S, Olajide O, Strayhorn D, Hinderliter A, diseases Orringer EP. Pulmonary hypertension in patients with sickle cell disease: a Mark Gladwin1,2 longitudinal study. Br J Haematol. 2006;134:109–15. 1University of Pittsburgh, Pittsburgh Heart, Lung, Blood and Vascular 2. De Castro LM, Jonassaint JC, Graham FL, Ashley‑Koch A and Telen MJ. Medicine Institut, Pittsburgh Pennsylvania, US; 2University of Pittsburgh, Pulmonary hypertension associated with sickle cell disease: clini‑ Division of Pulmonary, Allergy and Critical Care Medicine, Department cal and laboratory endpoints and disease outcomes. Am J Hematol. of Medicine, Pittsburgh Pennsylvania, US 2008;83:19–25. Correspondence: Mark Gladwin ‑ [email protected] 3. Gladwin MT, Sachdev V, Jison ML, Shizukuda Y, Plehn JF, Minter K, Brown Journal of Translational Medicine 2019, 17(2):S 1‑01 B, Coles WA, Nichols JS, Ernst I, Hunter LA, Blackwelder WC, Schechter AN, Rodgers GP, Castro O and Ognibene FP. Pulmonary hypertension as Introduction: Nitric oxide (NO) is a critical regulator of vascular home- a risk factor for death in patients with sickle cell disease. N Engl J Med. ostasis, increasing basal and fow-mediated vasodilation. Red blood 2004;350:886–95. cells can regulate NO bioavailability through an intrinsic nitrite (NO 2 ) 4. Machado RF, Anthi A, Steinberg MH, Bonds D, Sachdev V, Kato GJ, Taveira‑ − reductase mechanism that generates NO during physiological and DaSilva AM, Ballas SK, Blackwelder W, Xu X, Hunter L, Barton B, Waclawiw pathological hypoxia. In contrast, red blood cell hemolysis releases M, Castro O and Gladwin MT. N‑terminal pro‑brain natriuretic peptide hemoglobin into plasma, where can react with and scavenge NO. In levels and risk of death in sickle cell disease. JAMA. 2006;296:310–8. this context, hemoglobin functions as an oxido-reductase: A nitrite- 5. Mehari A, Alam S, Tian X, Cuttica MJ, Barnett CF, Miles G, Xu D, Seamon reductase and NO synthase when it deoxygenates and an NO oxidase C, Adams‑Graves P, Castro OL, Minniti CP, Sachdev V, Taylor JGt, Kato GJ, when it is oxygenated, particularly in the setting of hemolysis. The Machado RF. Hemodynamic predictors of mortality in adults with sickle mechanistic linkage between hemolytic anemia and vasculopathy has cell disease. Am J Respir Crit Care Med. 2013;187:840–7. been the subject of extensive study in pre-clinical animal models, in 6. Mehari A, Gladwin MT, Tian X, Machado RF, Kato GJ. Mortality in vascular studies in patients, and in large human cohort studies. Intra- adults with sickle cell disease and pulmonary hypertension. JAMA. vascular hemolysis releases cell-free hemoglobin into the plasma, 2012;307:1254–6. which can scavenge NO and generate reactive oxygen species, impair- 7. Fonseca GH, Souza R, Salemi VM, Jardim CV, Gualandro SF. Pulmonary ing redox balance and leading to proliferative systemic and pulmo- hypertension diagnosed by right heart catheterisation in sickle cell nary vasculopathy. Pre-clinical studies also suggest that sGC may be disease. Eur Respir J. 2012;39:112–8. oxidized in sickle cell disease, and responsive to sGC activator therapy. 8. Parent F, Bachir D, Inamo J, Lionnet F, Driss F, Loko G, Habibi A, Bennani It has also been recently appreciated that products released from the S, Savale L, Adnot S, Maitre B, Yaici A, Hajji L, O’Callaghan DS, Clerson P, red cell during hemolysis, including heme released from hemoglobin, Girot R, Galacteros F, Simonneau G. A hemodynamic study of pulmonary can be considered danger associated molecular pattern molecules or hypertension in sickle cell disease. N Engl J Med. 2011;365:44–53. erythrocyte “DAMPs” (eDAMPs). Large screening studies of patients 9. Caughey MC, Poole C, Ataga KI, Hinderliter AL. Estimated pulmonary with sickle cell disease (SCD) for the presence of pulmonary hyperten- artery systolic pressure and sickle cell disease: a meta‑analysis and sys‑ sion (PH) have been performed using non-invasive Doppler-echocar- tematic review. Br J Haematol. 2015;170:416–24. diography, screening biomarkers such as N-terminal brain natriuretic 10. Gladwin MT. Cardiovascular complications and risk of death in sickle‑cell peptide and right heart catheterization. These studies have reported disease. Lancet. 2016;387:2565–74. a high prevalence of PH in this population, a signifcant association of 11. Reiter CD, Wang X, Tanus‑Santos JE, Hogg N, Cannon RO, III, Schechter increasing pulmonary pressures with more severe hemolytic anemia, AN, Gladwin MT. Cell‑free hemoglobin limits nitric oxide bioavailability in cutaneous leg ulcerations, systemic systolic hypertension and renal sickle‑cell disease. Nat Med. 2002;8:1383–1389. dysfunction, and a high prospective associated risk of death. These 12. Rother RP, Bell L, Hillmen P, Gladwin MT. The clinical sequelae of studies support a more general pathological role for intravascular intravascular hemolysis and extracellular plasma hemoglobin: a novel hemolysis and cell-free hemoglobin in various human diseases and in mechanism of human disease. JAMA. 2005;293:1653–62. transfusion medicine. 13. Gladwin MT, Ofori‑Acquah SF. Erythroid DAMPs drive infammation in SCD. Blood. 2014;123:3689–90. © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/ publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated. J Transl Med 2019, 17(Suppl 2):254 Page 2 of 39 14. Donadee C, Raat NJ, Kanias T, Tejero J, Lee JS, Kelley EE, Zhao X, Liu C, Introduction: There are no disease-modifying therapies for SSc or its Reynolds H, Azarov I, Frizzell S, Meyer EM, Donnenberg AD, Qu L, Triulzi more severe difuse cutaneous form. The sGC stimulator rio showed D, Kim‑Shapiro DB, Gladwin MT. Nitric oxide scavenging by red blood cell vasodilatory, anti-fbrotic, and anti-remodeling properties in animal microparticles and cell‑free hemoglobin as a mechanism for the red cell models and efcacy in patients (pts) with pulmonary arterial hyper- storage lesion. Circulation. 2011;124:465–76. tension associated with connective tissue disease. It was therefore hypothesized that rio might provide beneft in pts with dcSSc. We pre- S 1‑02 sent results from the RISE-SSc study (NCT02283762) of rio in pts with Evaluating soluble guanylate cyclase stimulation for serious early dcSSc. central nervous system diseases Methods: Inclusion criteria were: dcSSc (by 2013 ACR/EULAR criteria; Christopher Winrow, Juli Jones, Rajesh Iyengar, Susana Correia, Sarah LeRoy criteria), disease duration 18 months, modifed Rodnan skin score (mRSS) 10 and 22 units≤ (range 0–51, higher score is worse), Jacobson, Guang Liu, Peter Germano, Jose Trevejo, Mark Currie, John ≥ ≤ Hadcock, Todd Milne forced vital capacity (FVC) 45% of predicted (%pred), and difusing capacity of the lung for CO≥ 40% pred at screening. Pts were rand- Cyclerion Therapeutics, Cambridge Massachusetts, US ≥ Correspondence: Todd Milne ‑ [email protected] omized to pbo or rio (0.5–2.5 mg 3 times daily). The primary endpoint Journal of Translational Medicine 2019, 17(2):S 1‑02 was change in mRSS from baseline (BL) to Week 52 (Wk52). Secondary endpoints included ACR Combined Response Index SSc (ACR CRISS), Introduction: The nitric oxide (NO)-soluble guanylate cyclase (sGC)- Health Assessment Questionnaire-Disability Index, and change in cGMP signaling pathway plays a fundamental role in modulating FVC%pred. A prespecifed exploratory analysis of mRSS progression diverse physiological processes within the central nervous system rate (increase of > 5 units and 25% from BL) and a post hoc analy- (CNS) including blood fow, infammation, neuroprotection, neuronal sis of lung function decline (FVC≥ %pred decline 10% absolute) were signaling, and metabolism. sGC stimulators are small-molecule ago- performed. Further exploratory efcacy endpoints≥ included changes nists of sGC that synergize with and enhance endogenous NO sign- in Raynaud’s phenomenon (RP) and digital ulcer (DU) burden. aling. As such, sGC stimulators may provide therapeutic benefts in Results: Overall, 121 pts (rio n 60, pbo n 61) were randomized diseases with impaired NO signaling. Many neurodegenerative dis- (mean SD age 51 12 years; 76%= female). =BL mRSS was compara- eases have associated neurovascular impairment and infammation ble between± rio and± pbo (mean SD 16.9 3.4 and 16.7 4.1). At that could be modulated with a CNS-penetrant sGC stimulator. Wk52, mRSS was 14.6 6.6 (rio) vs 15.7± 10.5± (pbo) (diference± of least Methods: Despite the promise of this mechanism in the treatment of squares means [95% ±CI] 2.3 [ 5.0, ±0.3], p 0.08). mRSS progres- CNS diseases, there have been limited pharmacological tools available sion rate favored rio ( 18%− [ 33.6,− 2.4], p = 0.02 [Mantel–Haenszel to modulate this pathway in the CNS. To evaluate the efects of a CNS- method]). ACR CRISS,− HAQ DI,− and FVC%pred− = showed no signifcant penetrant sGC stimulator (IW-6463), we conducted a series of nonclini- diference between the arms. At Wk52, lung function declined in 11% cal studies. of rio pts vs 20% of pbo pts.
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