PULMONER ARTERİYEL HİPERTANSİYON TEDAVİSİNDE GÜNCEL YAKLAŞIMLAR

Year 2021, Volume: 45 Issue: 2, 379 - 399, 31.05.2021

Cenk Yıldız , Burcu Devrim

https://doi.org/10.33483/jfpau.796831

Abstract

Amaç: Pulmoner arteriyel hipertansiyon (PAH), yüksek morbidite ve mortaliteye sahip kronik bir hastalıktır. PAH için uygulanan tedavi stratejileri hastaların yaşam kalitesinin iyileşmesini sağlamakla birlikte, hastaların büyük çoğunluğu için PAH, tedavi olasılığı olmayan hayatı sınırlayan bir hastalık olmaya devam etmektedir. Mevcut PAH tedavisinde karşılaşılan en önemli sorunlar hasta uyuncunun düşük olması ve yan etkilerin görülmesidir. Bu derlemede, PAH tedavisinde rhoA/rho kinaz, tirozin kinaz, endotel progenitör hücreleri, vazoaktif bağırsak peptiti ve miRNA gibi çeşitli yeni moleküler yolakların potansiyeli tartışılmıştır. Ayrıca, tedavide kullanılmak üzere onaylanmış ve inceleme aşamasında olan etkin maddelerin etkinliğini artırmak için hedeflendirilmiş ilaç taşıyıcı sistemlerin kullanımına yönelik çeşitli yöntemler değerlendirilmiştir.

Sonuç ve Tartışma: PAH, pulmoner vasküler direncin artması ve sonunda sağ kalp yetmezliği ve ölümle sonuçlanan ilerleyici pulmoner vasküler fonksiyonel ve yapısal değişikliklerle karakterize kronik bir hastalıktır. PAH patofizyolojisinden sorumlu hücresel ve moleküler mekanizmalar hakkındaki bilgilerin artması PAH tedavisinde yeni terapötik yaklaşımların oluşmasını sağlamıştır. Bu yaklaşımlar arasında rhoA/rho kinaz, tirozin kinaz, endotel progenitör hücreleri, vazoaktif bağırsak peptiti ve miRNA gibi çeşitli yeni moleküler yolakların kullanımı yer almaktadır. Ayrıca, PAH tedavisinde ilaç taşıyıcı sistemlerin kullanımı etkin maddelerin lokal olarak etki bölgesine hedeflendirilmesini sağlayarak optimum etkinin elde edilmesi ve yan etki görülme potansiyelinin azaltılması açısından umut verici olmuştur.

Keywords

Hedeflendirilmiş tedavi, ilaç taşıyıcı sistemler, pulmoner arteriyel hipertansiyon, tedavi stratejileri

CURRENT APPROACHES IN PULMONARY ARTERIAL HYPERTENSION TREATMENT

Abstract

Objective: Pulmonary arterial hypertension (PAH) is a cronic disease with high morbidity and mortality. Although the applied treatment strategies provide an improvement in the quality of life of the patients, PAH continues to be a life-limiting disease for most patients, without the possibility of treatment. The most important problems encountered in the current therapies for PAH are patient incompliance and off-target side effects. In this review, the potential of various new molecular pathways such as rhoA/rho kinase, tyrosine kinase, endothelial progenitor cells, vasoactive intestinal peptide and miRNA are discussed in the treatment of PAH. In addition, various methods for the use of targeted drug delivery systems have been evaluated to improve the efficacy of approved and investigational drugs.

Result and Discussion: PAH is a cronic disease characterized by increased pulmonary vascular resistance and progressive pulmonary vascular functional and structural changes that eventually result in right heart failure and death. Increasing knowledge about the cellular and molecular mechanisms responsible for PAH pathophysiology has led to the emergence of new therapeutic approaches for PAH treatment. These approaches include the use of various new molecular pathways such as rhoA/rho kinase, tyrosine kinase, endothelial progenitor cells, vasoactive intestinal peptide, and miRNA. Furthermore, the use of drug delivery systems in the treatment of PAH has been promising in terms of achieving the optimum effect and reducing the potential for side effects by ensuring that the active substances are targeted locally to the effect area.

Keywords

Drug delivery systems, pulmonary arterial hypertension, targeted therapy, treatment strategies

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