SUPPORT-1 (Subjects Undergoing PCI and Perioperative Reperfusion Treatment): A Prospective, Randomized Trial of CMX-2043 in Patients Undergoing Elective Percutaneous Coronary Intervention.

Objective: The natural molecule α-lipoic acid has been shown to be partially cytoprotective through antioxidant and antiapoptotic mechanisms. To obtain an initial assessment of the safety and potential efficacy of a synthetic derivative, CMX-2043, in preventing ischemic complications of percutaneous coronary intervention (PCI) we conducted the Subjects Undergoing PCI and Perioperative Reperfusion Treatment (SUPPORT-1) trial, the first patient experience with this agent.

Methods And Results: SUPPORT-1 was a phase 2a, 6-center, international, placebo-controlled, randomized, double-blind trial.

CMX-2043 Mechanisms of Action In Vitro.

α-Lipoic acid has been shown to provide cytoprotection in some tissues through antioxidant and antiapoptotic mechanisms. We have enhanced these properties by synthetic modification, resulting in a new chemical entity, CMX-2043, with proven efficacy in an animal model of cardiac ischemia-reperfusion injury. The present studies compare cytoprotective cellular pathways of R-α-lipoic acid and CMX-2043.

CMX-2043 Efficacy in a Rat Model of Cardiac Ischemia-Reperfusion Injury.

α-Lipoic acid (LA) has been shown to offer protection against ischemia-reperfusion injury (IRI) in multiple organ systems. N-[(R)-1,2-dithiolane-3-pentanoyl]-L-glutamyl-L-alanine (CMX-2043), a novel analogue of LA, was studied as part of a preclinical development program intended to identify safe and efficacious drug candidates for prevention or reduction in myocardial IRI. This study was designed to evaluate the efficacy of CMX-2043 in an animal model of myocardial IRI and to establish effective dosing conditions.

Pre-clinical and Clinical Safety Studies of CMX-2043: a cytoprotective lipoic acid analogue for ischaemia-reperfusion injury.

CMX-2043 is an α-lipoic acid analogue targeted to reduction of cellular injury and organ damage due to ischaemia-reperfusion injury (IRI). It has been shown to be effective in a rat model of cardiac IRI. The studies here reported evaluate its safety and pharmacokinetic profile in preparation for human clinical studies in procedures associated with IRI.

Lipoic acid analogs with enhanced pharmacological activity.

Lipoic acid (1,2-dithiolane-3-pentanoic acid) is a pharmacophore with unique antioxidant and cytoprotective properties. We synthesized a library based upon the condensation of natural and unnatural amino acids with the carboxylic acid moiety of lipoic acid. SAR studies were conducted using a cardiac ischemia-reperfusion animal model.

Antisecretory effect of splanchnic nerve stimulation on choleratoxin-induced secretion in the cat, an effect mediated at the crypts.

The experiments were performed on cats anaesthetized with alpha-chloralose. Segments of the small intestine were perfused with sodium-free hypotonic choline-mannitol solution and intestinal net fluid transport was recorded with a volumetric technique. The content of sodium and chloride in the lamina propria of the small intestinal villus was measured with an electron microprobe in freeze-dried paraffin embedded tissue.

Rupture of coronary vasa vasorum as a trigger of acute myocardial infarction.

Some controversy has always existed regarding the presence and extent of the vasa vasorum--the nutrient vessels in the wall of the human aorta--in the coronary arteries. Now, cinemicrographic studies using silicone polymer injections in cleared human hearts have identified the vasa vasorum of coronary arteries, revealing evidence of neovascularization in the region of atherosclerotic plaques. These studies suggest an important role for the vasa vasorum in the pathogenesis of coronary atherosclerosis and its sequelae, especially intramural hemorrhage and vascular spasm.

Villus and crypt electrolyte and fluid transport during intestinal secretion.

The apical parts of jejunal villi of net-absorbing intestine have been shown to contain sodium chloride concentration gradients which are associated with water absorption (Sjöqvist & Beeuwkes 1989). To determine whether these gradients are different in states of intestinal net secretion, jejunal segments of chloralose-anaesthetized cats were perfused with modified Krebs-Henseleit solutions while secretion was elicited by cholera toxin or vasoactive intestinal polypeptide (VIP). The segments were then rapidly frozen and freeze-dried, and sodium and chloride contents of the lamina propria of single villi were measured by X-ray microanalysis.

Villous sodium gradient associated with volume absorption in the feline intestine: an electron-microprobe study on freeze-dried tissue.

Water transport in biological tissue is driven by local osmotic gradients created by accumulation of actively transported ions in tissue compartments. To localize and measure such gradients, jejunal segments from the small intestine of anaesthetized cats were perfused with modified isotonic Krebs-Henseleit electrolyte solution, and net fluid transport was measured with a volumetric technique. The segments were then rapidly frozen, freeze-dried, and prepared for X-ray micro-analysis of elemental content.

Essential hereditary hypertension in dogs: a new animal model.

The objective of this project is to characterize a genetically determined model of essential hypertension in dogs. A pair of unrelated dogs with essential hypertension were identified. Breeding of these dogs and back-cross matings have resulted in 24 offspring, approximately half of which have essential hypertension (systolic blood pressure 170 mmHg, diastolic 105 mmHg).

Contrasting views on the action of atrial peptides: lessons from studies of conscious animals.

In a rather short time, a consensus seems to have emerged among researchers regarding the mechanisms of the natriuretic and hypotensive actions of atrial natriuretic factor (ANF). According to the by now classic view, the natriuresis induced by ANF is mediated by changes in renal hemodynamics; vasorelaxation is proposed as the primary mechanism of its hypotensive action. Recent evidence, mostly from experiments with conscious animals, does not support this view.

The effect of atrial natriuretic factor on blood pressure, heart rate, and renal functions in conscious, spontaneously hypertensive rats.

Atrial natriuretic factors, polypeptides released by atrial myocytes, may play a role in the control of blood pressure and the regulation of renal salt and water excretion. Our studies were designed to assess the role of a synthetic peptide, atriopeptin II, on blood pressure and heart rate, renal hemodynamics, and salt and water excretion in conscious, spontaneously hypertensive rats and in normotensive Wistar-Kyoto rats. Changes in mean arterial pressure and heart rate were recorded following intravenous bolus injections (0.

Transmembrane potential of renal papillary epithelial cells: effect of urea and DDAVP.

To define how renal papillary epithelial cells respond to wide changes in the ionic and osmotic composition of their environment, measurements were made of the transmembrane potential differences (PD) of rat renal papillary epithelial cells in vitro in media containing 100 mM NaCl, 100 mM KCl, 1.5 mM CaCl2, and 1 mM MgSO4 plus varying amounts of urea and/or sucrose up to 1,400 mM. Glass microelectrodes (resistance 25-75 M Omega) were used.

Urolithiasis in rats with diabetes insipidus (Brattleboro strain rats).

Brattleboro strain rats homozygous for hypothalamic diabetes insipidus (DI rat) excrete nearly their body weight per day in dilute urine and yet can form bladders stones composed of struvite and apatite. Studies were undertaken to investigate this apparent paradox. The results show that DI rat urine is indeed undersaturated with respect to struvite and apatite.

Oral antidiuretic therapy: studies in the diabetes insipidus rat.

In hypothalamic diabetes insipidus, water balance is achieved primarily through the thirst mechanism. The administration of an antidiuretic agent in the drinking water should restore the antidiuretic response to volume and osmoregulatory drive. To test this hypothesis, homozygous Brattleboro strain rats were given arginine vasopressin (AVP) or 1-desamino-8-D-arginine vasopressin (dDAVP) in the drinking water in concentrations of 10-10,000 micrograms/l (AVP) and 5-10,000 micrograms/l (dDAVP).

The renin angiotensin system in conscious Brattleboro strain rats.

Plasma renin activity (PRA) was measured in conscious Brattleboro strain, vasopressin (AVP)-deficient diabetes insipidus (DI) and heterozygous rats with the aid of chronically implanted catheters. Baseline, dehydration-stimulated, and hemorrhage-stimulated levels of PRA were elevated in DI rats, as compared to levels in heterozygous controls. Replacement therapy with either AVP or the nonpressor AVP analog dDAVP reduced PRA to control levels.

Application of scanning electron microscopy to x-ray analysis of frozen-hydrated sections. III. Elemental content of cells in the rat renal papillary tip.

The electrolyte and water content of cellular and interstitial compartments in the renal papilla of the rat was determined by x-ray microanalysis of frozen-hydrated tissue sections. Papillae from rats on ad libitum water were rapidly frozen in a slush of Freon 12, and sectioned in a cryomicrotome at -30 to -40 degrees C. Frozen 0.

Application of scanning electron microscopy to x-ray analysis of frozen-hydrated sections. II. Analysis of standard solutions and artificial electrolyte gradients.

New specimen handling and analytic techniques for the application of x-ray microanalysis to studies of cell and organ biology have been recently described (Saubermann et al., 1981, J. Cell Biol.

Application of scanning electron microscopy to x-ray analysis of frozen-hydrated sections. I. Specimen handling techniques.

X-ray microanalysis of frozen-hydrated tissue sections permits direct quantitative analysis of diffusible elements in defined cellular compartments. Because the sections are hydrated, elemental concentrations can be defined as wet-weight mass fractions. Use of these techniques should also permit determination of water fraction in cellular compartments.