Citrulline is a non-proteinogenic amino acid that forms as by-product in nitric oxide (NO) synthesis from arginine and may act in concert with NO as an independent signaling molecule that involves in the mechanism of vascular smooth muscle vasodilation. In this study we examined the effects of citrulline on pulmonary artery smooth muscles. Experimental design comprised outward potassium currents measurements in enzymatically isolated rat pulmonary artery smooth muscle (PASMc) cells using whole-cell patch clamp technique, isometric contractile force recordings on rat pulmonary artery rings and method of molecular docking simulation. Citrulline in a concentration 10-9-10-5 M relaxed phenylephrine (PHE)-preactivated SM of rat pulmonary artery in a dose-dependent manner (EC50 0,67 μM). This citrulline-induced relaxation was dependent on an intact endothelium. Bath application of citrulline (10-8-10-5 M) on isolated PASMc induced a significant increase in the amplitude of outward potassium current (Ik). The adenosine antagonist caffeine (10-6 M) effectively blocked both the citrulline-induced relaxation response and Ik increment. Molecular docking modeling suggests that caffeine blocking the potent activity of citrulline results from competitive interactions at the A2 adenosine receptor binding site. In summary, our data suggest that citrulline, released with NO at low concentrations, can effectively interact with adenosine receptors in smooth muscle cells, causing their relaxation, indicating surprising interaction between NO and adenosine pathways.

• MeSH
• arteria pulmonalis účinky léků   metabolismus   MeSH
• citrulin * farmakologie   metabolismus   MeSH
• krysa rodu rattus MeSH
• potkani Wistar MeSH
• purinergní receptory P1 metabolismus   MeSH
• simulace molekulového dockingu * MeSH
• svaly hladké cévní metabolismus   účinky léků   MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Pulmonary hypertension is a cardiovascular disease with a low survival rate. The protein galectin-3 (Gal-3) binding β-galactosides of cellular glycoproteins plays an important role in the onset and development of this disease. Carbohydrate-based drugs that target Gal-3 represent a new therapeutic strategy in the treatment of pulmonary hypertension. Here, we present the synthesis of novel hydrophilic glycopolymer inhibitors of Gal-3 based on a polyoxazoline chain decorated with carbohydrate ligands. Biolayer interferometry revealed a high binding affinity of these glycopolymers to Gal-3 in the subnanomolar range. In the cell cultures of cardiac fibroblasts and pulmonary artery smooth muscle cells, the most potent glycopolymer 18 (Lac-high) caused a decrease in the expression of markers of tissue remodeling in pulmonary hypertension. The glycopolymers were shown to penetrate into the cells. In a biodistribution and pharmacokinetics study in rats, the glycopolymers accumulated in heart and lung tissues, which are most affected by pulmonary hypertension.

• MeSH
• arteria pulmonalis účinky léků   metabolismus   MeSH
• biologické markery MeSH
• fibroblasty účinky léků   metabolismus   MeSH
• galektin 3 * antagonisté a inhibitory   metabolismus   MeSH
• krysa rodu rattus MeSH
• kultivované buňky MeSH
• lidé MeSH
• plicní hypertenze * farmakoterapie   metabolismus   MeSH
• polymery chemie   farmakologie   MeSH
• tkáňová distribuce MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Endothelin-1 (ET-1) induces pulmonary vascular remodeling and pulmonary hypertension secondary to pulmonary fibrosis. Given that endothelial cells are the main source of ET-1 and ET-1 from other cells may encounter difficulty penetrating vascular compartments, we hypothesize that endothelial-derived ET-1 promotes vascular remodeling secondary to pulmonary fibrosis. We used vascular endothelial ET-1 knock-out (VEETKO) and Wild type mice for this research. They were given intratracheal bleomycin and euthanized at day 28. We quantified pulmonary fibrosis, measured lung ET-1 and its receptors' expression, and assessed pulmonary vascular remodeling by calculating medial wall index, muscularization index, adventitial collagen and adventitial fibroblast and macrophage accumulation. Right ventricle remodeling was also assessed. Both VEETKO and Wild type mice developed comparable pulmonary fibrosis and similar fibrosis-related gene expression. Compared to Wild type mice, bleomycin-induced VEETKO mice had lower ET-1 peptide levels (15.4 pg/mg vs. 31.2 pg/mg, p<0.01). Expression of both ET-1 receptors mRNAs were increased in fibrosis models. Bleomycin-induced fibrosis VEETKO mice had significantly less muscularized arterioles, lower muscularization index and attenuated adventitial collagen, fibroblast and macrophage accumulation as compared to that of Wild type mice. Right ventricular pressure, hypertrophy and fibrosis did not increase both in VEETKO and Wild type mice despite the more enhanced vascular remodeling in Wild type. In conclusion, endothelial-derived endothelin-1 promotes pulmonary vascular remodeling secondary to bleomycin-induced pulmonary fibrosis.

• MeSH
• arteria pulmonalis účinky léků   metabolismus   patologie   MeSH
• bleomycin toxicita   MeSH
• cévní endotel metabolismus   patologie   MeSH
• endotelin-1 metabolismus   MeSH
• myši knockoutované MeSH
• myši transgenní MeSH
• myši MeSH
• plicní fibróza chemicky indukované   metabolismus   MeSH
• remodelace cév účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: We compared the haemodynamic effects of riociguat in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent/recurrent CTEPH after pulmonary endarterectomy in the Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Trial 1 study. METHODS: Patients with inoperable or persistent/recurrent CTEPH (n=261; mean± SD age 59±14 years; 66% women) were randomised to riociguat (up to 2.5 mg three times daily) or placebo. Haemodynamic parameters were assessed at baseline and week 16. RESULTS: Riociguat decreased pulmonary vascular resistance (PVR) in inoperable (n=189; least-squares mean difference: -285 dyn s/cm(5) (95% CI -357 to -213); p<0.0001) and persistent/recurrent (n=72; -131 dyn s/cm(5) (95% CI -214 to -48); p=0.0025) patients. Cardiac index improved in inoperable patients by a least-squares mean difference of +0.6 L/min/m(2) (95% CI 0.4 to 0.7; p<0.0001), while in persistent/recurrent patients the change was +0.2 L/min/m(2) (95% CI -0.1 to 0.5; p=0.17). Mean pulmonary artery pressure decreased in inoperable and persistent/recurrent patients(-4.7 mm Hg (95% CI -6.9 to -2.6; p<0.0001 and -4.8 mm Hg (-8.2 to -1.5; p=0.0055), respectively). For all patients, changes in 6 min walk distance correlated with changes in PVR (r=-0.29 (95% CI -0.41 to -0.17); p<0.0001) and cardiac index (r=0.23 (95% CI 0.10 to 0.35); p=0.0004). CONCLUSIONS: Riociguat improved haemodynamics in patients with inoperable CTEPH or persistent/recurrent CTEPH. TRIAL REGISTRATION NUMBER: NCT00855465.

• MeSH
• antihypertenziva škodlivé účinky   terapeutické užití   MeSH
• arteria pulmonalis účinky léků   patofyziologie   MeSH
• arteriální tlak účinky léků   MeSH
• časové faktory MeSH
• cévní rezistence účinky léků   MeSH
• chronická nemoc MeSH
• dvojitá slepá metoda MeSH
• endarterektomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• metoda nejmenších čtverců MeSH
• obnova funkce MeSH
• plicní embolie komplikace   diagnóza   MeSH
• plicní hypertenze diagnóza   farmakoterapie   etiologie   patofyziologie   MeSH
• prospektivní studie MeSH
• pyrazoly škodlivé účinky   terapeutické užití   MeSH
• pyrimidiny škodlivé účinky   terapeutické užití   MeSH
• recidiva MeSH
• senioři MeSH
• test chůzí MeSH
• tolerance zátěže účinky léků   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Previous studies have suggested that the Notch signaling pathway plays a very important role in the proliferation and differentiation of pulmonary microvascular endothelial cells (PMVECs). Therefore, we aimed to investigate the expression level of Notch-related signaling molecules in PMVECs in bleomycin (BLM)-induced rat pulmonary fibrosis. Immunohistochemistry, immunofluorescence, Western blotting, and real-time PCR were used to analyze the differences in protein and mRNA expression levels of Notch-related signaling molecules, i.e. Notch1, Jagged1, Delta-like ligand 4 (Dll4), and hairy and enhancer of split homolog 1 (Hes1), between a control group treated with intratracheal instillation of saline and a study group treated with intratracheal instillation of BLM solution. Expression levels of the receptor Notch1 and one of its ligands, Jagged1, were upregulated, while the expression levels of the ligand Dll4 and the target molecule of the Notch signaling pathway, Hes1, were downregulated. The differences in protein and mRNA expression levels between the control and study groups were significant (p<0.001). The Jagged1/Notch1 signaling pathway is activated in the pathogenesis of BLM-induced rat pulmonary fibrosis, while the Dll4/Notch1 signaling pathway is inhibited, which inhibits the suppressive effect of Dll4/Notch1 signaling on PMVEC overproliferation, further causing PMVEC dysfunction in cell sprouting and maturation as well as abnormal differentiation of the cell phenotype. Conversely, the down-expression of Hes1 indicates that the Jagged1/Notch1 signaling pathway could be a non-canonical Notch signaling pathway independent of Hes1 activation, which differs from the canonical Dll4/Notch1 signaling pathway.

• MeSH
• arteria pulmonalis účinky léků   metabolismus   MeSH
• bleomycin MeSH
• endoteliální buňky účinky léků   metabolismus   MeSH
• krysa rodu rattus MeSH
• kultivované buňky MeSH
• mezibuněčné signální peptidy a proteiny metabolismus   MeSH
• mikrocévy metabolismus   MeSH
• plicní fibróza chemicky indukované   metabolismus   MeSH
• receptory Notch metabolismus   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Few controlled clinical trials exist to support oral combination therapy in pulmonary arterial hypertension (PAH). METHODS: Patients with PAH (idiopathic [IPAH] or associated with connective tissue disease [APAH-CTD]) taking bosentan (62.5 or 125 mg twice daily at a stable dose for ≥3 months) were randomized (1:1) to sildenafil (20 mg, 3 times daily; n = 50) or placebo (n = 53). The primary endpoint was change from baseline in 6-min walk distance (6MWD) at week 12, assessed using analysis of covariance. Patients could continue in a 52-week extension study. An analysis of covariance main-effects model was used, which included categorical terms for treatment, baseline 6MWD (<325 m; ≥325 m), and baseline aetiology; sensitivity analyses were subsequently performed. RESULTS: In sildenafil versus placebo arms, week-12 6MWD increases were similar (least squares mean difference [sildenafil-placebo], -2.4 m [90% CI: -21.8 to 17.1 m]; P = 0.6); mean ± SD changes from baseline were 26.4 ± 45.7 versus 11.8 ± 57.4 m, respectively, in IPAH (65% of population) and -18.3 ± 82.0 versus 17.5 ± 59.1 m in APAH-CTD (35% of population). One-year survival was 96%; patients maintained modest 6MWD improvements. Changes in WHO functional class and Borg dyspnoea score and incidence of clinical worsening did not differ. Headache, diarrhoea, and flushing were more common with sildenafil. CONCLUSIONS: Sildenafil, in addition to stable (≥3 months) bosentan therapy, had no benefit over placebo for 12-week change from baseline in 6MWD. The influence of PAH aetiology warrants future study. TRIAL REGISTRATION: ClinicalTrials.gov NCT00323297 (registration date: May 5, 2006).

• MeSH
• antagonisté endotelinového receptoru aplikace a dávkování   škodlivé účinky   MeSH
• antihypertenziva aplikace a dávkování   škodlivé účinky   MeSH
• arteria pulmonalis účinky léků   patofyziologie   MeSH
• arteriální tlak účinky léků   MeSH
• časové faktory MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• inhibitory fosfodiesterasy 5 aplikace a dávkování   škodlivé účinky   MeSH
• kombinovaná farmakoterapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• metoda nejmenších čtverců MeSH
• obnova funkce MeSH
• plicní hypertenze diagnóza   farmakoterapie   patofyziologie   MeSH
• senioři MeSH
• sildenafil citrát aplikace a dávkování   škodlivé účinky   MeSH
• sulfonamidy aplikace a dávkování   škodlivé účinky   MeSH
• test chůzí MeSH
• tolerance zátěže účinky léků   MeSH
• vazodilatancia aplikace a dávkování   škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

Pulmonary hypertension (PH), associated with imbalance in vasoactive mediators and massive remodeling of pulmonary vasculature, represents a serious health complication. Despite the progress in treatment, PH patients typically have poor prognoses with severely affected quality of life. Asymmetric dimethyl arginine (ADMA), endogenous inhibitor of endothelial nitric oxide synthase (eNOS), also represents one of the critical regulators of pulmonary vascular functions. The present study describes a novel mechanism of ADMA-induced dysfunction in human pulmonary endothelial and smooth muscle cells. The effect of ADMA was compared with well-established model of hypoxia-induced pulmonary vascular dysfunction. It was discovered for the first time that ADMA induced the activation of signal transducer and activator of transcription 3 (STAT3) and stabilization of hypoxia inducible factor 1α (HIF-1α) in both types of cells, associated with drastic alternations in normal cellular functions (e.g., nitric oxide production, cell proliferation/Ca(2+) concentration, production of pro-inflammatory mediators, and expression of eNOS, DDAH1, and ICAM-1). Additionally, ADMA significantly enhanced the hypoxia-mediated increase in the signaling cascades. In summary, increased ADMA may lead to manifestation of PH phenotype in human endothelial and smooth muscle cells via the STAT3/HIF-1α cascade. Therefore this signaling pathway represents the potential pathway for future clinical interventions in PH.

• MeSH
• amidohydrolasy metabolismus   MeSH
• arginin analogy a deriváty   farmakologie   MeSH
• arteria pulmonalis účinky léků   metabolismus   patofyziologie   MeSH
• endoteliální buňky účinky léků   metabolismus   MeSH
• faktor 1 indukovatelný hypoxií - podjednotka alfa metabolismus   MeSH
• hypoxie buňky MeSH
• kultivované buňky MeSH
• lidé MeSH
• mediátory zánětu metabolismus   MeSH
• mezibuněčná adhezivní molekula-1 metabolismus   MeSH
• myocyty hladké svaloviny účinky léků   metabolismus   MeSH
• oxid dusnatý metabolismus   MeSH
• plicní hypertenze etiologie   metabolismus   patofyziologie   MeSH
• proliferace buněk účinky léků   MeSH
• signální transdukce účinky léků   MeSH
• svaly hladké cévní účinky léků   metabolismus   patofyziologie   MeSH
• synthasa oxidu dusnatého, typ III metabolismus   MeSH
• transkripční faktor STAT3 metabolismus   MeSH
• vápník metabolismus   MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

AIM OF THE STUDY: In rats, the environment with low content of oxygen induces hypoxic pulmonary hypertension. Remodeling of pulmonary resistance arteries is particularly triggered by the mast cell degranulation products, e.g., rodent-like interstitial collagenase (matrix metalloproteinase 13). Administration of sodium cromoglycate leads to stabilization of mast cell granules, and thus to the modified remodeling process. MATERIALS AND METHODS: During four-day hypoxia, we treated rats with sodium cromoglycate. Pulmonary vascular remodeling was assessed as well as counts of periarterial pulmonary mast cells, both total and matrix metalloproteinase 13-positive ones. RESULTS: Four-day hypoxia induced remodeling of both resistance arteries and large conduit arteries. We have found increase in the tunica media thickness of resistance arteries. Tunica adventitia thickness of both resistance arteries and large conduit arteries with a diameter of over 300 μm increased as well; the latter ones revealed increase in the number of vasa vasorum in their walls. Mast cell stabilization suppressed hypoxic pulmonary vascular remodeling in resistance pulmonary arteries. Four-day hypoxia led to changes in distribution of toluidine blue-detected and MMP-13 positive periarterial mast cells; this redistribution was also influenced by the administration of sodium cromoglycate. CONCLUSIONS: The number of pulmonary periarterial mast cells seemingly decreases during hypoxia due to their degranulation, which disables their identification. Large conduit arteries do not affect final blood pressure in the pulmonary vascular bed; however, their structure changes substantially under hypoxia. Such remodeling changes are not mediated by mast cell products only since they have occurred in spite of stabilization of mast cell granules.

• MeSH
• arteria pulmonalis účinky léků   metabolismus   patofyziologie   MeSH
• hypoxie metabolismus   patofyziologie   MeSH
• kromoglykát dvojsodný farmakologie   MeSH
• krysa rodu rattus MeSH
• kyslík metabolismus   MeSH
• mastocyty účinky léků   metabolismus   MeSH
• matrixová metaloproteinasa 13 metabolismus   MeSH
• plíce účinky léků   metabolismus   patofyziologie   MeSH
• plicní hypertenze metabolismus   patofyziologie   MeSH
• potkani Wistar MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Pulmonary hypertension and right ventricular (RV) dysfunction are common in patients with advanced heart failure with preserved ejection fraction (HFpEF), yet their underlying mechanisms remain poorly understood. We sought to examine RV-pulmonary artery (PA) functional reserve responses and RV-PA coupling at rest and during β-adrenergic stimulation in subjects with earlier stage HFpEF. METHODS AND RESULTS: In a prospective trial, subjects with HFpEF (n=39) and controls (n=18) underwent comprehensive invasive and noninvasive hemodynamic assessment using high fidelity micromanometer catheters, echocardiography, and expired gas analysis at rest and during dobutamine infusion. HFpEF subjects displayed similar RV structure but significantly impaired RV systolic (lower RV dP/dtmax/IP and s') and diastolic function (higher RV τ) coupled with more severe pulmonary vascular disease, manifest by higher PA pressures, higher PA resistance, and lower PA compliance compared with controls. Dobutamine infusion caused greater pulmonary vasodilation in HFpEF compared with controls, with enhanced reductions in PA resistance, greater increase in PA compliance, and a more negative slope in the PA pressure-flow relationship when compared with controls (all P<0.001). RV-PA coupling analysis revealed that dobutamine improved RV ejection in HFpEF subjects through afterload reduction alone, rather than through enhanced contractility, indicating RV systolic reserve dysfunction. CONCLUSIONS: Pulmonary hypertension in early stage HFpEF is related to partially reversible pulmonary vasoconstriction coupled with RV systolic and diastolic dysfunction, even in the absence of RV structural remodeling. Pulmonary vascular tone is more favorably responsive to β-adrenergic stimulation in HFpEF than controls, suggesting a potential role for β-agonists in the treatment of patients with HFpEF and pulmonary hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01418248.

• MeSH
• agonisté beta-1-adrenergních receptorů aplikace a dávkování   MeSH
• arteria pulmonalis účinky léků   patofyziologie   MeSH
• arteriální tlak * účinky léků   MeSH
• diagnostické techniky kardiovaskulární MeSH
• dobutamin aplikace a dávkování   MeSH
• dysfunkce pravé srdeční komory diagnóza   farmakoterapie   etiologie   patofyziologie   MeSH
• funkce levé komory srdeční účinky léků   MeSH
• funkce pravé komory srdeční * účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• parenterální infuze MeSH
• plicní hypertenze diagnóza   farmakoterapie   etiologie   patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční selhání komplikace   diagnóza   farmakoterapie   patofyziologie   MeSH
• tepový objem * účinky léků   MeSH
• vazodilatace * účinky léků   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH
• práce podpořená grantem MeSH

Plicní arteriální hypertenze (PAH) je primární onemocnění plicních arteriol, které je charakterizováno progresivním zvyšování plicní vaskulární rezistence a tlaku v plicním oběhu. Postupně vede k hypertrofii pravé komory srdeční, dále pak bez léčby k jejímu selhávání a k úmrtí nemocného. Etiologie plicní hypertenze (PH) byla opakovaně reklasifikována, naposledy na 4. světovém sympoziu plicní hypertenze v roce 2008 [1]. V první skupině je právě PAH, která vzniká buď z neznámé příčiny, nebo je asociována se známou vyvolávající příčinou (systémová onemocnění pojiva, jaterní onemocnění, vrozené zkratové srdeční vady, HIV infekce, abúzus některých anorektik). Současnou medikamentózní léčbu PAH rozdělujeme na konvenční (antikoagulační léčba, blokátory kalciových kanálů, léčba srdečního selhání) a specifickou (prostanoidy, antagonisté endotelinových receptorů, inhibitory fosfodiesterázy 5). Nemocní s pozitivním vazodilatačním testem jsou indikováni k léčbě vysokými dávkami blokátorů kalciových kanálů. U nemocných s negativním vazodilatačním testem je indikována chronická antikoagulační léčba a specifická farmakoterapie používaná buď jako monoterapie nebo jako léčba kombinační. Poslední roky přinesly celou řadu zcela nových léčebných postupů, především v oblasti farmakoterapie, zkoušejí se však také postupy jiné, např. využití kmenových buněk. Ke zkoušeným farmakům patří několik skupin látek: 1. vazodilatancia: fasudil, adrenonedullin, aktivátory a stimulátory guanylátcyklázy, vazoaktivní intestinální peptid (VIP); 2. látky protizánětlivě působící: inhibitor elastázy, antagonista B buněk, imunosupresiva, inhibitor HDAC1; 3. látky ovlivňující metabolizmus: nitrity, antagonisté PPAR, antioxidanty, antagonisté receptorů pro serotonin a blokátory serotoninového transportéru, statiny, inhibitory Rho-kinázy; 4. induktory apoptózy buněk hladkého svalstva: inhibitory tyrozinkinázy, inhibitory elastázy; 5. ovlivnění regenerace cév: apelin, léčba cílená na buňky endotelu, náhrada BMPR2.

Pulmonary arterial hypertension (PAH) is a primary pulmonary arteriolar disease, characterized by a progressive increase in pulmonary vascular resistance and pressure in the pulmonary circulation. It progressively leads to hypertrophy of the right ventricle and with no treatment to its failure and patient´s death. Etiology of pulmonary hypertension (PH) has been reclassified repeatedly, most recently during the 4th World Symposium on Pulmonary Hypertension held in 2008 [1]. Currently, the first group contains PAH with either unknown or known cause (systemic connective tissue disease, liver disease, congenital heart disease, HIV infection, abuse of anorexic agents). Current drug therapy of PAH is divided into conventional (anticoagulant therapy, calcium channel blockers, therapy of chronic heart failure) and specific (prostanoids, endothelium receptor antagonists, phosphodiesterase 5 inhibitors). Patients with positive vasodilator test are indicated for the high doses treatment of calcium channel blockers. Patients with negative vasodilator test are indicated for chronic anticoagulant therapy and specific drug therapy either as mono-therapy, or as combined therapy. Recent years have brought a wide range of new treatments modalities, especially in the field of pharmacotherapy. In addition, other treatment modalities have been tested, for example application of stem cells. Drugs in research include several groups: 1. vasodilators: fasudil, adrenonedullin, activators and stimulators of guanylate cyclase, vasoactive intestinal peptide (VIP); 2. Anti-inflammatory agents: inhibitor of elastase, antagonist of B cells, immunosuppressive agents, inhibitor of HDAC1; 3. agents affecting metabolism: nitrites, PPAR antagonists, antioxidants, serotonin receptor antagonist and serotonin transporter blockers, statins, inhibitors of Rho-kinase; 4. apoptosis inductors of smooth muscle cells: tyrosine-kinase inhibitors, elastase inhibitors; 5. agents influencing vascular regeneration: apelin, treatment targeted to endothelial cells, replacement of BMPR2.

• MeSH
• acetamidy MeSH
• antagonisté endotelinového receptoru A MeSH
• antagonisté endotelinového receptoru B MeSH
• antagonisté endotelinového receptoru MeSH
• antihypertenziva * klasifikace   MeSH
• arteria pulmonalis účinky léků   MeSH
• epoprostenol MeSH
• guanylátcyklasa antagonisté a inhibitory   MeSH
• inhibitory agregace trombocytů MeSH
• inhibitory fosfodiesterasy 5 MeSH
• klinické zkoušky jako téma MeSH
• kombinovaná farmakoterapie MeSH
• léčivé přípravky klasifikace   MeSH
• lidé MeSH
• plicní hypertenze * farmakoterapie   MeSH
• preklinické hodnocení léčiv MeSH
• prostaglandiny MeSH
• pyraziny MeSH
• receptor endotelinu A MeSH
• receptor endotelinu B MeSH
• receptory endotelinů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH