Role of Endothelin-A (ETA) and Endothelin-B (ETB) Receptors in the Vasodilatory Response to Endothelin-3 (ET-3)

Study Overview
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Brief Summary
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Endothelin-1 (ET-1) has been linked to a number of conditions including pulmonary arterial hypertension (PAH). ET-1 acts via 2 receptors, ETA and ETB. The ET-1 receptor blockers bosentan and sitaxsentan have been shown to be beneficial in patients with PAH. Bosentan blocks both ETA and ETB receptors. Sitaxsentan selectively blocks ETA receptors. Theoretically, selective ETA blockade may be associated with greater vasodilation and clearance of ET-1 by leaving the ETB receptor unblocked. This has not been directly studied in humans. We aim to investigate the endothelial ETB-mediated vascular responses between bosentan and sitaxsentan by using a ETB selective agonist (ET-3). We hypothesise that at clinically relevant doses: Bosentan will show evidence of ETB receptor blockade compared to sitaxsentan and placebo. These effects will be confirmed by 2 functional markers of ETB receptor antagonism: plasma ET-1 (a very sensitive, but not necessarily clinically relevant marker), and the forearm vasodilator response to ET-3.

Official Title
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Characterisation of the Role of ETA and ETB Receptors in Regulating Plasma ET-1 and the Vasodilator Response to ET-3 in Man

Conditions
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Pulmonary Arterial Hypertension, Vasodilation, Vasoconstriction

Intervention / Treatment
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* Drug: Bosentan
* Drug: Sitaxsentan
* Drug: Placebo
* Biological: Endothelin-3


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy men and post-menopausal women Age 18-70 years BMI 18-35 kg/m2 Exclusion Criteria: Are mentally or legally incapacitated Have donated blood within the last 4 weeks Have a history of past or present drug or alcohol abuse Have participated in another clinical trial within 1 month Are considered to be at a high risk of HIV or Hepatitis B Are taking routine medicines Are women taking hormone replacement therapy Have significant medical or psychiatric illness

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Bosentan<br>Bosentan 125mg twice daily will be taken for 7 days, before ET-1 plasma sample taken. ET-3 infusion (5mins) and associated forearm blood flow study (60 mins) will also occur after 7 days of bosentan therapy | Drug: Bosentan<br>* Bosentan 125mg tablets, orally, twice daily for 7 days<br>* Other names: Tracleer;Biological: Endothelin-3<br>* 5 minute local intra-arterial infusion of endothelin-3 at a rate of rate of 60 pmol/min, during forearm blood flow studies<br>|
| Experimental: Sitaxsentan<br>Sitaxsentan 100mg once daily + placebo tablet will be taken for 7 days, before ET-1 plasma sample taken. ET-3 infusion (5mins) and associated forearm blood flow study (60 mins) will also occur after 7 days of sitaxsentan therapy | Drug: Sitaxsentan<br>* Sitaxsentan 100mg tablets, orally, once daily for 7 days<br>* Other names: Thelin;Drug: Placebo<br>* Placebo tablets taken twice daily, orally, for 7 days (placebo arm) or once daily for 7 days (sitaxsentan arm)<br>Biological: Endothelin-3<br>* 5 minute local intra-arterial infusion of endothelin-3 at a rate of rate of 60 pmol/min, during forearm blood flow studies<br>|
| Placebo Comparator: Placebo<br>Placebo tablet twice daily will be taken for 7 days, before ET-1 plasma sample taken. ET-3 infusion (5mins) and associated forearm blood flow study (60 mins) will also occur after 7 days of placebo therapy | Drug: Placebo<br>* Placebo tablets taken twice daily, orally, for 7 days (placebo arm) or once daily for 7 days (sitaxsentan arm)<br>Biological: Endothelin-3<br>* 5 minute local intra-arterial infusion of endothelin-3 at a rate of rate of 60 pmol/min, during forearm blood flow studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plasma ET-1 after 7-day administration of bosentan, sitaxsentan and placebo |  | 7 days | 
| Responses to ET-3 (maximum vasodilation after ET-3 administration and area under the curve of vasodilation) after bosentan compared with the results from sitaxsentan and placebo. |  | 60 mins | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Forearm Blood Flow, Vasodilation, Vasoconstriction, Endothelin System, Endothelin-1, Endothelin-3, Endothelin antagonists, Bosentan, Sitaxsentan, Endothelin, Regional Blood Flow