Tranilast for Advanced Heart Failure in Patients with Muscular Dystrophy: A Single-Arm, Open-Label, Multicenter Study

Background: The transient receptor potential cation channel subfamily V member 2 (TRPV2) is a stretch-sensitive calcium channel. TRPV2 overexpression in the sarcolemma of skeletal and cardiac myocytes causes calcium influx into the cytoplasm, which triggers myocyte degeneration. In animal models of cardiomyopathy and muscular dystrophy (MD), TRPV2 inhibition was effective against heart failure and motor function. Our previous pilot study showed that tranilast, a TRPV2 inhibitor, reduced brain natriuretic peptide (BNP) levels in two MD patients with advanced heart failure. Thus, this single-arm, open-label, multicenter study aimed to evaluate the safety and efficacy of tranilast for heart failure.Methods: The study enrolled MD patients with advanced heart failure whose serum BNP levels were >100 pg/mL despite receiving standard cardioprotective therapy. Tranilast was administered orally at 100 mg, thrice daily. The primary endpoint was the change in log (BNP) (⊿log [BNP]) at 6 months from baseline. The null hypothesis was determined based on a previous multicenter study of carvedilol results in a mean population ⊿log (BNP) of 0.18. TRPV2 expression on peripheral blood mononuclear cell surface, cardiac events, total mortality, left ventricular fractional shortening, human atrial natriuretic peptide, cardiac troponin T, and creatine kinase, and pinch strength were also assessed.Results: Because of the poor general condition of many patients, only 18 of 34 patients were included and 13 patients could be treated according to the protocol throughout the 6 month period. However, there were no serious adverse events related to tranilast except diarrhea, a known adverse effect, and the drug was administered safely. TRPV2 expression on the mononuclear cell surface was elevated at baseline and reduced after treatment. Cardiac biomarkers such as BNP, human atrial natriuretic peptide, and fractional shortening remained stable, suggesting a protective effect against the progression of heart failure. In the per protocol set group, ⊿log (BNP)was -0.2 and significantly lower than that in the null hypothesis.Conclusions: Tranilast is safe and effective in inhibiting TRPV2 expression, even in MD patients with advanced heart failure. Further trials are needed to evaluate the efficacy of tranilast in preventing myocardial damage, heart failure, motor impairment, and respiratory failure.Clinical Trial Registration Details: The study was registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000031965, URL: http://www.umin.ac.jp/ctr/) [March 30, 2018] and the Japan Registry of Clinical Trials (jRCT, registration number: jRCTs031180038, URL: https://jrct.niph.go.jp/) [November 12, 2021]. Patient registration was started in December 19, 2018.

Role of the New Bioimpedance Monitoring Device (Seca®) and Human Atrial Natriuretic Peptide in Assessing Volume Status in Hemodialysis Patients

Background There is no evidence on how to use the information from bioimpedance analysis (BIA) devices in clinical management, including setting of target dry weight (DW), or improving outcomes in hemodialysis (HD) patients. Methods Here, we investigate preferable cut off values of fluid status (extracellular water/total body water ratio; ECW/TBW) detected by a new and more accurate BIA device (Seca®) in 78 HD patients. Results Patients with an ECW/TBW of more than 45% and human atrial natriuretic peptide (HANP) value of > 50 pg/mL had a higher blood pressure and cardio-thoracic ratio on chest x-ray examination.Conclusions Our results suggests that ECW/TBW of more than 45% and HANP value of > 50 pg/mL were overhydrated and had a worse prognosis.