The
sodium-hydrogen exchanger isoform-1 (NHE-1) plays an important role in the myocardial response to
ischemia-reperfusion; inhibition of this exchanger protects against ischemic injury, including reduction in
infarct size. Herein we describe a novel, potent, and highly selective NHE-1 inhibitor,
zoniporide (
CP-597,396; [1-(quinolin-5-yl)-5-cyclopropyl-1H-
pyrazole-4-carbonyl]
guanidine).
Zoniporide inhibits human NHE-1 with an IC(50) of 14 nM, has >150-fold selectivity vs. other NHE
isoforms, and potently inhibits ex vivo NHE-1-dependent swelling of human platelets. This compound is well tolerated in preclinical animal models, exhibits moderate
plasma protein binding, has a t(1/2) of 1.5 h in monkeys, and has one major active metabolite. In both in vitro and in vivo rabbit models of
myocardial ischemia-
reperfusion injury,
zoniporide markedly reduced
infarct size without adversely affecting hemodynamics or cardiac function. In the isolated heart (Langendorff),
zoniporide elicited a concentration-dependent reduction in
infarct size (EC(50) = 0.25 nM). At 50 nM it reduced
infarct size by 83%. This compound was 2.5-20-fold more potent than either
eniporide or
cariporide (EC(50)s of 0.69 and 5.11 nM, respectively), and reduced
infarct size to a greater extent than
eniporide. In open chest, anesthetized rabbits,
zoniporide also elicited a dose-dependent reduction in
infarct size (ED(50) = 0.45 mg/kg/h) and inhibited NHE-1-mediated platelet swelling (93% inhibition at 4 mg/kg/h). Furthermore,
zoniporide attenuated postischemic cardiac contractile dysfunction in conscious primates, and reduced both the incidence and duration of
ischemia-reperfusion-induced
ventricular fibrillation in rats.
Zoniporide represents a novel class of potent and selective human NHE-1 inhibitors with potential utility for providing cardioprotection in a clinical setting.