title: Nupafant, a PAF-antagonist prototype for suppression of ventricular fibrillation without liability for QT prolongation?
abstract: OBJECTIVE
  PAF antagonists inhibit ischaemia-induced ventricular fibrillation (VF) in animals. However, unfavourable ancillary actions (on QT interval and coronary flow) have been reported with the PAF antagonist, BN-50739. If these are class actions, they would preclude development of PAF antagonists as novel anti-VF drugs. Our purpose was to examine this proposition using the hitherto untested PAF antagonist, nupafant.
  
  
  METHODS
  Two rat heart preparations (Langendorff and 'dual coronary' perfusion) were used to assay nupafant's effects on ischaemia-induced VF, coronary flow and QT interval, and to test for the site-selectivity necessary if any effects on VF are caused by PAF antagonism.
  
  
  RESULTS
  Global (whole-heart) delivery of 10 microM nupafant, reduced the incidence of ischaemia-induced VF and widened QT interval without affecting coronary flow. Importantly, lower concentrations (0.1 and 1 microM) had no effect on VF, yet widened QT almost identically to 10 microM nupafant. When nupafant was delivered selectively to (and entrapped within) the involved region it partially protected against VF (P<0.05). This occurred without change in QT interval. Selective nupafant delivery to the uninvolved region was without effect.
  
  
  CONCLUSIONS
  Nupafant protects against ischaemia-induced VF primarily by site-selective actions in the ischaemic region but, unlike BN-50739, the effect is unrelated to its QT widening action, and is not compromised by any effect on coronary flow. This establishes proof of concept that VF suppression by PAF antagonism need not invariably be associated with QT prolongation or vasodilatation, justifying further development of this drug class.
authors.affiliation: Cardiovascular Division, Rayne Institute, St Thomas' Hospital, London, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Baker
authors.forename: L M
authors.initials: LM
authors.lastname: Wood
authors.forename: M
authors.initials: M
authors.lastname: Whittaker
authors.forename: M J
authors.initials: MJ
authors.lastname: Curtis
mesh_terms: D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography / Q000187:drug effects*; D007930:Leucine / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors* / Q000502:physiology; D051381:Rats; D017208:Rats, Wistar; D013449:Sulfonamides / Q000494:pharmacology*; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000889:Anti-Arrhythmia Agents; D010972:Platelet Activating Factor; D013449:Sulfonamides; C515030:nupafant; D007930:Leucine