Therapies for pulmonary arterial hypertension: where are we today, where do we go tomorrow?
نویسندگان
چکیده
Pulmonary arterial hypertension (PAH) is a progressive disease characterised by remodelling of small pulmonary arteries leading to an increased pulmonary vascular resistance, right ventricular failure and death. Available treatments try to re-establish the equilibrium on three signalling pathways: the prostacyclin, the endothelin (ET)-1 and the nitric oxide. Prostanoids, such as epoprostenol or treprostinil have a vasodilator, antiproliferative and immunomodulatory effect and, despite the administration inconveniences, represent established therapies for severe cases of PAH. Recently oral prostacyclin receptor agonists have shown encouraging results. Many clinical studies targeting the vasoconstrictor ET-1 pathway with receptor antagonists like bosentan and ambrisentan have shown strong results, even more optimism coming from macitentan, the newest drug. Sildenafil and tadalafil, two phosphodiesterase type-5 inhibitors, have shown improved exercise capacity by increasing the nitric oxide level. Riociguat, acting on the same nitric oxide pathway, as a guanylatecyclase activator, has shown promising results in clinical trials and will be available soon. Long-awaited results for tyrosin-kinase inhibitor, imatinib, as an antiproliferative therapy in PAH have been disappointing, due to severe adverse events. In conclusion, although it remains a disease with severe prognosis, the past 20 years have represented a huge progress in terms of treatments for PAH with interesting opportunities for the future.
منابع مشابه
Evidence - based CAM: Where does it stand?
In the past 10 years evidence - based medicine (EBM) has developed well in all aspects of allopathic medicine giving a new dimension to patient care including cost reduction and attention to medical ethics. With the public and medical community return to complementary and alternative medicine (CAM) in the last two decades there has been a call for evidence - based CAM … in the same way that all...
متن کاملEvidence - based CAM: Where does it stand?
In the past 10 years evidence - based medicine (EBM) has developed well in all aspects of allopathic medicine giving a new dimension to patient care including cost reduction and attention to medical ethics. With the public and medical community return to complementary and alternative medicine (CAM) in the last two decades there has been a call for evidence - based CAM … in the same way that all...
متن کاملA case of severe pulmonary hypertension associated with common arterial trunk and VSD in a 9 years old child
Background: Common arterial trunk (CAT) is a rare congenital heart disease, and often leads to the early development of pulmonary hypertension and disability. Among the critical structural heart defects, the frequency of CAT is 3%, which reflects the severe hemodynamic disturbances. The natural course of the disease is characterized by a high mortality rate up to 88% during the first year of li...
متن کاملVirulence of Helicobacter Pylori: Yesterday, Today and Tomorrow
Abstract Undoubtedly, H. pylori is the major human gastric pathogen, which infects the mucosal epithelium in 50% of world population. However, H. pylori infection is relatively prevalent globally the majority of infected individuals are asymptomatic. The recent epidemiological studies show that the various gastro intestinal complications can be the result of genetic variation in H. pylori stra...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- European respiratory review : an official journal of the European Respiratory Society
دوره 22 129 شماره
صفحات -
تاریخ انتشار 2013