In rat pulmonary arteries, dual endothelin receptor antagonists like bosentan may potentiate endothelin-1 constriction by blocking ETB-mediated clearance, providing mechanistic insights relevant to PAH therapy.
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Raises caution for dual ERAs in PAH; leaves open whether ETB clearance effects translate to patients.
Dual endothelinETAandETBreceptor antagonists are approved therapy for pulmonary artery hypertension (PAH). We hypothesized thatETBreceptor‐mediated clearance of endothelin‐1 at specific vascular sites may compromise this targeted therapy. Concentration‐response curves (CRC) to endothelin‐1 or theETBagonist sarafotoxin S6c were constructed, with endothelin receptor antagonists, in various rat and mouse isolated arteries using wire myography or in rat isolated trachea. In rat small mesenteric arteries, bosentan displaced endothelin‐1CRCcompetitively indicative ofETAreceptor antagonism. In rat small pulmonary arteries, bosentan 10 μmol L−1left‐shifted the endothelin‐1CRC, demonstrating potentiation consistent with antagonism of anETBreceptor‐mediated endothelin‐1 clearance mechanism. Removal of endothelium or L‐NAMEdid not alter theEC50or Emax of endothelin‐1 nor increase the antagonism byBQ788. In the presence ofBQ788 and L‐NAME, bosentan displayedETAreceptor antagonism. In rat trachea (ETB), bosentan was a competitiveETBantagonist against endothelin‐1 or sarafotoxin S6c. Modeling showed the importance of dual receptor antagonism where the potency ratio ofETAtoETBantagonism is close to unity. In conclusion, the rat pulmonary artery is an example of a special vascular bed where the resistance to antagonism of endothelin‐1 constriction byETdual antagonists, such as bosentan or theETBantagonistBQ788, is possibly due to the competition of potentiation of endothelin‐1 by blockade ofETB‐mediated endothelin‐1 clearance located on smooth muscle and antagonism ofETA‐ andETB‐mediated contraction. This conclusion may have direct application for the efficacy of endothelin‐1 antagonists for treatingPAH.
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Angus et al. (2017) studied this question.
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