Tolvaptan plus pasireotide shows enhanced efficacy in a PKD1 model.

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is a leading cause of ESRD. A central defect associated with ADPKD pathology is elevated levels of 3', 5'-cyclic AMP (cAMP). Compounds such as tolvaptan and pasireotide, which indirectly reduce adenylyl cyclase 6 (AC6) activity, have hence proven effective in slowing cyst progression. Here, we tested the efficacy of these compounds individually and in combination in a hypomorphic PKD1 model, Pkd1(R3277C/R3277C) (Pkd1(RC/RC)), in a 5-month preclinical trial. Initially, the Pkd1(RC/RC) model was inbred into the C57BL/6 background, minimizing disease variability, and the pathogenic effect of elevating cAMP was confirmed by treatment with the AC6 stimulant desmopressin. Treatment with tolvaptan or pasireotide alone markedly reduced cyst progression and in combination showed a clear additive effect. Furthermore, combination treatment significantly reduced cystic and fibrotic volume and decreased cAMP to wild-type levels. We also showed that Pkd1(RC/RC) mice experience hepatic hypertrophy that can be corrected by pasireotide. The observed additive effect reinforces the central role of AC6 and cAMP in ADPKD pathogenesis and highlights the likely benefit of combination therapy for patients with ADPKD.

• Authors: Katharina Hopp, Cynthia J Hommerding, Xiaofang Wang, Hong Ye, Peter C Harris, Vicente E Torres
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 26 Issue 1 Pg. 39-47 (Jan 2015) ISSN: 1533-3450 [Electronic] United States
• PMID: 24994926 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 by the American Society of Nephrology.

Chemical References

• Antidiuretic Agents
• Antidiuretic Hormone Receptor Antagonists
• Benzazepines
• TRPP Cation Channels
• polycystic kidney disease 1 protein
• Tolvaptan
• Somatostatin
• pasireotide
• Cyclic AMP
• Deamino Arginine Vasopressin

Topics

• Animals
• Antidiuretic Agents (administration & dosage)
• Antidiuretic Hormone Receptor Antagonists (administration & dosage)
• Benzazepines (administration & dosage)
• Cell Line, Tumor
• Cell Membrane (metabolism)
• Cyclic AMP (metabolism)
• Deamino Arginine Vasopressin (administration & dosage)
• Disease Models, Animal
• Drug Therapy, Combination
• Female
• Humans
• Male
• Mice
• Mice, Inbred C57BL
• Mice, Transgenic
• Microsatellite Repeats (genetics)
• Models, Genetic
• Polycystic Kidney, Autosomal Dominant (drug therapy, genetics)
• Somatostatin (administration & dosage, analogs & derivatives)
• TRPP Cation Channels (genetics)
• Tolvaptan