title: Sunitinib-induced systemic vasoconstriction in swine is endothelin mediated and does not involve nitric oxide or oxidative stress.
abstract: Angiogenesis inhibition with agents targeting tyrosine kinases of vascular endothelial growth factor receptors is an established anticancer treatment, but is, unfortunately, frequently accompanied by systemic hypertension and cardiac toxicity. Whether vascular endothelial growth factor receptor antagonism also has adverse effects on the pulmonary and coronary circulations is presently unknown. In chronically instrumented awake swine, the effects of the vascular endothelial growth factor receptor antagonist sunitinib on the systemic, pulmonary, and coronary circulation were studied. One week after sunitinib (50 mg PO daily), mean aortic blood pressure (MABP) had increased from 83±5 mm Hg at baseline to 97±6 mm Hg (P<0.05) because of a 57±20% increase in systemic vascular resistance as cardiac output decreased. In contrast, sunitinib had no discernible effects on pulmonary and coronary hemodynamics or cardiac function. We subsequently investigated the mechanisms underlying the sunitinib-induced systemic hypertension. Intravenous administration of NO synthase inhibitor N(G)-nitro-l-arginine increased MABP by 24±1 mm Hg under baseline conditions, whereas it increased MABP even further after sunitinib administration (32±3 mm Hg; P<0.05). Reactive oxygen species scavenging with a mixture of antioxidants lowered MABP by 13±2 mm Hg before but only by 5±2 mm Hg (P<0.05) after sunitinib administration. However, intravenous administration of the dual endothelin A/endothelin B receptor blocker tezosentan, which did not lower MABP at baseline, completely reversed MABP to presunitinib values. These findings indicate that sunitinib produces vasoconstriction selectively in the systemic vascular bed, without affecting pulmonary or coronary circulations. The sunitinib-mediated systemic hypertension is principally attributed to an increased vasoconstrictor influence of endothelin, with no apparent contributions of a loss of NO bioavailability or increased oxidative stress.
authors: Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Mariëtte H W
authors: MH
authors: Kappers
authors: Vincent J
authors: VJ
authors: de Beer
authors: Zhichao
authors: Z
authors: Zhou
authors: A H Jan
authors: AH
authors: Danser
authors: Stefan
authors: S
authors: Sleijfer
authors: Dirk J
authors: DJ
authors: Duncker
authors: Anton H
authors: AH
authors: van den Meiracker
authors: Daphne
authors: D
authors: Merkus
mesh_terms: D020533:Angiogenesis Inhibitors / Q000494:pharmacology; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D019332:Endothelin-1 / Q000378:metabolism*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D007211:Indoles / Q000494:pharmacology*; D008297:Male; D009043:Motor Activity / Q000502:physiology; D009569:Nitric Oxide / Q000378:metabolism*; D018384:Oxidative Stress / Q000502:physiology*; D011652:Pulmonary Circulation / Q000187:drug effects / Q000502:physiology; D011758:Pyrroles / Q000494:pharmacology*; D017382:Reactive Oxygen Species / Q000378:metabolism; D012146:Rest / Q000502:physiology; D000077210:Sunitinib; D034421:Sus scrofa; D014661:Vasoconstriction / Q000187:drug effects* / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D019332:Endothelin-1; D007211:Indoles; D011758:Pyrroles; D017382:Reactive Oxygen Species; D009569:Nitric Oxide; D000077210:Sunitinib