Cardiac Physiology and Chronobiology - Safety … · Basics of heart conductive system ... The...
Transcript of Cardiac Physiology and Chronobiology - Safety … · Basics of heart conductive system ... The...
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Safety Pharmacology Society Webinar:
Cardiac Physiology and Chronobiology
Maxim Soloviev, MD, PhD, DSP Incyte Corporation, Wilmington, DE
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Overview
Basics of heart conductive system ECG 101 Diurnal variability in different species
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Cardiac conduction system Impulse initiated by the Sinus
Node. It travels to the atriums and to the
Atrioventricular (AV) Node located between the chambers
The AV Node slows the impulse down and passes it through to the AV Bundle (or Bundle of His)
Bundle of His divides itself into two tracts through the ventricles and the Purkinje Fibers, which stimulate muscle of the ventricles
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ECG and Cardiac Activity Electrocardiogram (ECG) is a
representation of the heart's electrical activity
The P wave, represents atrial depolarization
The QRS complex represents ventricular depolarization
The ST segment represents the repolarization of the ventricles
The QT interval represents ventricular depolarization and repolarization
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AV Node
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Normal ECG
Normal duration and amplitude of ECG waves, complexes, and segments is variable in different species
E.g. QT/RR ratio in normal conditions human > monkey > dog
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How to Think about Heart Rhythm
Site of Origin Rate Regularity
Electrical ImpulseFormation
•Sinus Node •Atrium •AV node •Ventricle
•Consistency
•Normal •Fast •Slow
•Regular •Irregular
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Sinus arrhythmia Common finding, more prominent in dogs
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Sinus bradyarrhythmia Common finding, more prominent in dogs,
especially during night hours (vagal prevalence)
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Sinus arrhythmia with ventricular escape complex Less common finding, still can be observed
in healthy animals
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AV block First degree AV block – prolongation of PR interval Second degree AV block
– Type 1 (aka Mobitz 1 or Wenckebach): Progressive prolongation of PR interval with dropped beats
– Type 2 (aka Mobitz 2 or Hay): PR interval remains unchanged prior to the P wave which suddenly fails to conduct to the ventricles.
Third degree AV block, also known as complete heart block, condition when impulse generated in the sinus node does not propagate to the ventricles
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2nd Degree AV Block, Type 2 Common finding in healthy animals, more frequent in
dogs
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3rd degree AV block Impulse generated in the sinus node, conducts
to atria but does not propagate to the ventricles If impulse for ventricles generated at AV node
or His Bundle before bifurcation, QRS complex can be of normal shape
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Single PVC Ventricular cell may initiate an impulse and
cause a premature ventricular contraction (PVC)
A single occurrence is seen quite often an does not cause any serious problems
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Multiple polytopic PVC Abnormal finding, may suggest myocardial damage
and/or issues with repolarization Frequent PVC dramatically increase probability of
polymorphic ventricular tachycardia aka Torsades de Pointes (TpD)
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Torsades de Pointes Torsades de pointes (TdP) – is a polymorphic ventricular
tachycardia that can cause sudden death Although uncommon, TPD is one of the most severe cardiac
side effects
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Chronopharmacology
Clench et al., 1981
Chronokinetics of Indomethacin (Human data)
Other examples: • Amitriptylin • Diasepam • Digoxin • Propranolol • Verapamil • Nidedipin • Theophyllin …
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v. Mayersbach, 1976
Same amount of drug given at a different time of the days may result in different exposure (Cmax, Tmax, AUC…) - Chronopharmacokynetics Same amount of drug given at a different time of the days may result in different pharmacodynamic response - Chronopharmacodynamics
Chronopharmacology
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Diurnal Variability in HR Difference between nocturnal and diurnal species
Sato et al, 1995; Soloviev at al, 2006; Stubban et al 2008
Minipigs
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Diurnal Variability in BP
Sato et al, 1995; Soloviev at al, 2006; Stubban et al 2008
Minipigs
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Diurnal Variability in Temperature
Stubban et al 2008; Soloviev at al, 2003; Soloviev at al, 2006
Minipigs
Rat, activity
Rat, temperature
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Diurnal Variation of QT interval
150
180
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240
270
300
60-70
70-80
80-90
90-10
0
100-1
10
110-1
20
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70
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90
Heart Rate (bpm)
QT
(mse
c)
NHP Light NHP Dark Dog Light Dog Dark
Difference up to 32 msec (12.7%)
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Suggested Literature Authier, S et al., A cardiovascular monitoring system in conscious cynomolgus monkeys for regulatory
safety pharmacology. Part 1: Non-pharmacological validation. J Pharmacol Toxicol Methods, 2007. 56: p. 115-121.
Brown AM Drugs, hERG and sudden death. (2004) Cell Calcium 35(6):543-547. Detweiler, D.K. (1988). The mammalian electrocardiogram, in Comprehensive Electrocardiography:
Theory and Practice in Health and Disease (MacFarlane, PW and Lawrie, T.D.V., eds.). Pergamon, New York.
Dubin D. Rapid Interpretation of EKG's. 2000. Hamlin RL. How many ECG leads are required for in vivo studies in safety pharmacology? (2008) J
Pharmacol Toxicol Methods. 57(3):161-8. Gauvin DV et al (2006) Spontaneous cardiac arrhythmias recorded in three experimentally- and drug-
naive laboratory species (canine, primate, swine) during standard pre-study screening. J Pharmacol Toxicol Methods. 59(2):57-61.
Gauvin, DV et al (2006). Electrocardiogram, hemodynamics, and core body temperatures of the normal freely moving cynomolgus monkey by remote radiotelemetry. J. Pharmacol. Toxicol.Methods 53(2):140–151.
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Suggested Literature Leishman, D et al., Best practice in key nonclinical cardiovascular assessments in drug development:
current recommendations from the SPS. J Pharmacol Toxicol Methods, 2012 May-Jun;65(3):93-101. Lemmer B. Relevance for chronopharmacology in practical medicine. Semin Perinatol. 2000
Aug;24(4):280-90. Lemmer B. Chronobiology, drug-delivery, and chronotherapeutics. Adv Drug Deliv Rev. 2007 Aug
31;59(9-10):825-7. Markert, M., et al., Validation of the normal, freely moving Göttingen minipig for pharmacological
safety testing. J Pharmacol Toxicol Methods, 2009. 60: p. 79-87. Mayersbach H. (1976). Time – a key in experimental and practical medicine. Arch. Toxicol. 36 185–
216. Sato, K. et al, Circadian and short-term variabilities in blood pressure and heart rate measured by
telemetry in rabbits and rats. J Auton Nerv Syst, 1995. 54(3): p. 235-46. Soloviev MV et al. (2006) Different species require different QT corrections. Cardiovascular
Toxicology, 6(2): 145-157. Soloviev MV et al. (2006). Variations in hemodynamic parameters and ECG in healthy conscious
freely moving telemetrized beagle dogs. Cardiovasc. Toxicol. 6(1):51–62. Tilley LP et al. Canine and Feline Cardiac Arrythmias Self Assesment. 1999.
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Thank you!
Questions?