Background/Aims: Organic nitrates represent a group of nitrovasodilators that are clinically used for the treatment of ischemic heart disease. The new compound CLC-3000 is an aminoethyl nitrate (AEN) derivative of pioglitazone, a thiazolidinedione antidiabetic agent combining the peroxisome proliferator-activated receptor γ agonist activity of pioglitazone with the NO-donating activity of the nitrate moiety. Methods: In vitro and in vivo characterization was performed by isometric tension recording, platelet function, bleeding time and detection of oxidative stress. Results: In vitro, CLC-3000 displayed more potent vasodilation than pioglitazone alone or classical nitrates. In vitro, some effects on oxidative stress parameters were observed. Authentic AEN or the AEN-containing linker CLC-1275 displayed antiaggregatory effects. In vivo treatment with CLC-3000 for 7 days did neither induce endothelial dysfunction nor nitrate tolerance nor oxidative stress. Acute or chronic administration of AEN increased the tail vein bleeding time in mice. Conclusion: In summary, the results of these studies demonstrate that CLC-3000 contains a vasodilative and antithrombotic activity that is not evident with pioglitazone alone, and that 7 days of exposure in vivo showed no typical signs of nitrate tolerance, endothelial dysfunction or other safety concerns in Wistar rats.

1.
Heitzer T, Krohn K, Albers S, Meinertz T: Tetrahydrobiopterin improves endothelium-dependent vasodilation by increasing nitric oxide activity in patients with type II diabetes mellitus. Diabetologia 2000;43:1435-1438.
2.
Heitzer T, Finckh B, Albers S, Krohn K, Kohlschutter A, Meinertz T: Beneficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free Radic Biol Med 2001;31:53-61.
3.
Hink U, Li H, Mollnau H, Oelze M, Matheis E, Hartmann M, Skatchkov M, Thaiss F, Stahl RA, Warnholtz A, Meinertz T, Griendling K, Harrison DG, Forstermann U, Munzel T: Mechanisms underlying endothelial dysfunction in diabetes mellitus. Circ Res 2001;88:E14-E22.
4.
Wenzel P, Schulz E, Oelze M, Muller J, Schuhmacher S, Alhamdani MS, Debrezion J, Hortmann M, Reifenberg K, Fleming I, Munzel T, Daiber A: AT1-receptor blockade by telmisartan upregulates GTP-cyclohydrolase I and protects eNOS in diabetic rats. Free Radic Biol Med 2008;45:619-626.
5.
Wautier MP, Chappey O, Corda S, Stern DM, Schmidt AM, Wautier JL: Activation of NADPH oxidase by age links oxidant stress to altered gene expression via RAGE. Am J Physiol Endocrinol Metab 2001;280:E685-E694.
6.
Yamamoto Y, Yamagishi S, Yonekura H, Doi T, Tsuji H, Kato I, Takasawa S, Okamoto H, Abedin J, Tanaka N, Sakurai S, Migita H, Unoki H, Wang H, Zenda T, Wu PS, Segawa Y, Higashide T, Kawasaki K, Yamamoto H: Roles of the AGE-RAGE system in vascular injury in diabetes. Ann NY Acad Sci 2000;902:163-170, discussion 170-172.
7.
Way JM, Harrington WW, Brown KK, Gottschalk WK, Sundseth SS, Mansfield TA, Ramachandran RK, Willson TM, Kliewer SA: Comprehensive messenger ribonucleic acid profiling reveals that peroxisome proliferator-activated receptor gamma activation has coordinate effects on gene expression in multiple insulin-sensitive tissues. Endocrinology 2001;142:1269-1277.
8.
Schuhmacher S, Oelze M, Bollmann F, Kleinert H, Otto C, Heeren T, Steven S, Hausding M, Knorr M, Pautz A, Reifenberg K, Schulz E, Gori T, Wenzel P, Munzel T, Daiber A: Vascular dysfunction in experimental diabetes is improved by pentaerithrityl tetranitrate but not isosorbide-5-mononitrate therapy. Diabetes 2011;60:2608-2616.
9.
Oelze M, Schuhmacher S, Daiber A: Organic nitrates and nitrate resistance in diabetes: the role of vascular dysfunction and oxidative stress with emphasis on antioxidant properties of pentaerithrityl tetranitrate. Exp Diabetes Res 2010;2010:213176.
10.
Daiber A, Munzel T, Gori T: Organic nitrates and nitrate tolerance - state of the art and future developments. Adv Pharmacol 2010;60:177-227.
11.
Schuhmacher S, Schulz E, Oelze M, Konig A, Roegler C, Lange K, Sydow L, Kawamoto T, Wenzel P, Munzel T, Lehmann J, Daiber A: A new class of organic nitrates: investigations on bioactivation, tolerance and cross-tolerance phenomena. Br J Pharmacol 2009;158:510-520.
12.
Knorr M, Hausding M, Schulz E, Oelze M, Rummler R, Schuff A, Daub S, Schreiner J, Kroller-Schon S, Wenzel P, Gori T, Burgin K, Sartor D, Scherhag A, Munzel T, Daiber A: Characterization of new organic nitrate hybrid drugs covalently bound to valsartan and cilostazol. Pharmacology 2012;90:193-204.
13.
Schuhmacher S, Wenzel P, Schulz E, Oelze M, Mang C, Kamuf J, Gori T, Jansen T, Knorr M, Karbach S, Hortmann M, Mathner F, Bhatnagar A, Forstermann U, Li H, Munzel T, Daiber A: Pentaerythritol tetranitrate improves angiotensin II-induced vascular dysfunction via induction of heme oxygenase-1. Hypertension 2010;55:897-904.
14.
Munzel T, Sayegh H, Freeman BA, Tarpey MM, Harrison DG: Evidence for enhanced vascular superoxide anion production in nitrate tolerance. A novel mechanism underlying tolerance and cross-tolerance. J Clin Invest 1995;95:187-194.
15.
Raha S, McEachern GE, Myint AT, Robinson BH: Superoxides from mitochondrial complex III: the role of manganese superoxide dismutase. Free Radic Biol Med 2000;29:170-180.
16.
Daiber A, Oelze M, August M, Wendt M, Sydow K, Wieboldt H, Kleschyov AL, Munzel T: Detection of superoxide and peroxynitrite in model systems and mitochondria by the luminol analogue L-012. Free Radic Res 2004;38:259-269.
17.
Wenzel P, Hink U, Oelze M, Seeling A, Isse T, Bruns K, Steinhoff L, Brandt M, Kleschyov AL, Schulz E, Lange K, Weiner H, Lehmann J, Lackner KJ, Kawamoto T, Munzel T, Daiber A: Number of nitrate groups determines reactivity and potency of organic nitrates: a proof of concept study in ALDH-2-/- mice. Br J Pharmacol 2007;150:526-533.
18.
Wendt MC, Daiber A, Kleschyov AL, Mulsch A, Sydow K, Schulz E, Chen K, Keaney JF Jr, Lassegue B, Walter U, Griendling KK, Munzel T: Differential effects of diabetes on the expression of the gp91phox homologues Nox1 and Nox4. Free Radic Biol Med 2005;39:381-391.
19.
Daiber A, August M, Baldus S, Wendt M, Oelze M, Sydow K, Kleschyov AL, Munzel T: Measurement of NAD(P)H oxidase-derived superoxide with the luminol analogue L-012. Free Radic Biol Med 2004;36:101-111.
20.
Wenzel P, Mollnau H, Oelze M, Schulz E, Wickramanayake JM, Muller J, Schuhmacher S, Hortmann M, Baldus S, Gori T, Brandes RP, Munzel T, Daiber A: First evidence for a crosstalk between mitochondrial and NADPH oxidase-derived reactive oxygen species in nitroglycerin-triggered vascular dysfunction. Antioxid Redox Signal 2008;10:1435-1447.
21.
Hink U, Li H, Mollnau H, Oelze M, Matheis E, Hartmann M, Skatchkov M, Thaiss F, Stahl RA, Warnholtz A, Meinertz T, Griendling K, Harrison DG, Forstermann U, Munzel T: Mechanisms underlying endothelial dysfunction in diabetes mellitus. Circ Res 2001;88:E14-E22.
22.
Oelze M, Mollnau H, Hoffmann N, Warnholtz A, Bodenschatz M, Smolenski A, Walter U, Skatchkov M, Meinertz T, Munzel T: Vasodilator-stimulated phosphoprotein serine 239 phosphorylation as a sensitive monitor of defective nitric oxide/cGMP signaling and endothelial dysfunction. Circ Res 2000;87:999-1005.
23.
Strassel C, Nonne C, Eckly A, David T, Leon C, Freund M, Cazenave JP, Gachet C, Lanza F: Decreased thrombotic tendency in mouse models of the Bernard-Soulier syndrome. Arterioscler Thromb Vasc Biol 2007;27:241-247.
24.
Tchaikovski SN, Van Vlijmen BJ, Rosing J, Tans G: Development of a calibrated automated thrombography based thrombin generation test in mouse plasma. J Thromb Haemost 2007;5:2079-2086.
25.
Hausding M, Jurk K, Daub S, Kroller-Schon S, Stein J, Schwenk M, Oelze M, Mikhed Y, Kerahrodi JG, Kossmann S, Jansen T, Schulz E, Wenzel P, Reske-Kunz AB, Becker C, Munzel T, Grabbe S, Daiber A: CD40L contributes to angiotensin II-induced pro-thrombotic state, vascular inflammation, oxidative stress and endothelial dysfunction. Basic Res Cardiol 2013;108:386.
26.
Frenette PS, Denis CV, Weiss L, Jurk K, Subbarao S, Kehrel B, Hartwig JH, Vestweber D, Wagner DD: P-selectin glycoprotein ligand 1 (PSGL-1) is expressed on platelets and can mediate platelet-endothelial interactions in vivo. J Exp Med 2000;191:1413-1422.
27.
Jurk K, Ritter MA, Schriek C, Van Aken H, Droste DW, Ringelstein EB, Kehrel BE: Activated monocytes capture platelets for heterotypic association in patients with severe carotid artery stenosis. Thromb Haemost 2010;103:1193-1202.
28.
Schuhmacher S, Schulz E, Oelze M, Konig A, Roegler C, Lange K, Sydow L, Kawamoto T, Wenzel P, Munzel T, Lehmann J, Daiber A: A new class of organic nitrates: investigations on bioactivation, tolerance and cross-tolerance phenomena. Br J Pharmacol 2009;158:510-520.
29.
Munzel T, Giaid A, Kurz S, Stewart DJ, Harrison DG: Evidence for a role of endothelin 1 and protein kinase C in nitroglycerin tolerance. Proc Natl Acad Sci USA 1995;92:5244-5248.
30.
Mollnau H, Oelze M, Zinssius E, Hausding M, Wu Z, Knorr M, Ghaemi Kerahrodi J, Kroller-Schon S, Jansen T, Teutsch C, Foster C, Li H, Wenzel P, Schulz E, Munzel T, Daiber A: Effects of telmisartan or amlodipine monotherapy versus telmisartan/amlodipine combination therapy on vascular dysfunction and oxidative stress in diabetic rats. Naunyn-Schmiedebergs Arch Pharmacol 2013;386:405-419.
31.
Sydow K, Daiber A, Oelze M, Chen Z, August M, Wendt M, Ullrich V, Mulsch A, Schulz E, Keaney JF Jr, Stamler JS, Munzel T: Central role of mitochondrial aldehyde dehydrogenase and reactive oxygen species in nitroglycerin tolerance and cross-tolerance. J Clin Invest 2004;113:482-489.
32.
Daiber A, Oelze M, Coldewey M, Bachschmid M, Wenzel P, Sydow K, Wendt M, Kleschyov AL, Stalleicken D, Ullrich V, Mulsch A, Munzel T: Oxidative stress and mitochondrial aldehyde dehydrogenase activity: a comparison of pentaerythritol tetranitrate with other organic nitrates. Mol Pharmacol 2004;66:1372-1382.
33.
Kurz S, Hink U, Nickenig G, Borthayre AB, Harrison DG, Munzel T: Evidence for a causal role of the renin-angiotensin system in nitrate tolerance. Circulation 1999;99:3181-3187.
34.
Munzel T, Harrison DG: Evidence for a role of oxygen-derived free radicals and protein kinase C in nitrate tolerance. J Mol Med (Berl) 1997;75:891-900.
35.
Munzel T, Kurz S, Rajagopalan S, Thoenes M, Berrington WR, Thompson JA, Freeman BA, Harrison DG: Hydralazine prevents nitroglycerin tolerance by inhibiting activation of a membrane-bound NADH oxidase. A new action for an old drug. J Clin Invest 1996;98:1465-1470.
36.
Knorr M, Hausding M, Kroller-Schuhmacher S, Steven S, Oelze M, Heeren T, Scholz A, Gori T, Wenzel P, Schulz E, Daiber A, Munzel T: Nitroglycerin-induced endothelial dysfunction and tolerance involve adverse phosphorylation and S-glutathionylation of endothelial nitric oxide synthase: beneficial effects of therapy with the AT1 receptor blocker telmisartan. Arterioscler Thromb Vasc Biol 2011;31:2223-2231.
37.
Oelze M, Knorr M, Kroller-Schon S, Kossmann S, Gottschlich A, Rummler R, Schuff A, Daub S, Doppler C, Kleinert H, Gori T, Daiber A, Munzel T: Chronic therapy with isosorbide-5-mononitrate causes endothelial dysfunction, oxidative stress, and a marked increase in vascular endothelin-1 expression. Eur Heart J 2013;34:3206-3216.
38.
Schnorbus B, Schiewe R, Ostad MA, Medler C, Wachtlin D, Wenzel P, Daiber A, Munzel T, Warnholtz A: Effects of pentaerythritol tetranitrate on endothelial function in coronary artery disease: results of the PENTA study. Clin Res Cardiol 2010;99:115-124.
39.
Thomas GR, DiFabio JM, Gori T, Parker JD: Once daily therapy with isosorbide-5-mononitrate causes endothelial dysfunction in humans: evidence of a free-radical-mediated mechanism. J Am Coll Cardiol 2007;49:1289-1295.
40.
Dragoni S, Gori T, Lisi M, Di Stolfo G, Pautz A, Kleinert H, Parker JD: Pentaerythrityl tetranitrate and nitroglycerin, but not isosorbide mononitrate, prevent endothelial dysfunction induced by ischemia and reperfusion. Arterioscler Thromb Vasc Biol 2007;27:1955-1959.
41.
Gori T, Al-Hesayen A, Jolliffe C, Parker JD: Comparison of the effects of pentaerythritol tetranitrate and nitroglycerin on endothelium-dependent vasorelaxation in male volunteers. Am J Cardiol 2003;91:1392-1394.
42.
Gori T, Daiber A: Non-hemodynamic effects of organic nitrates and the distinctive characteristics of pentaerithrityl tetranitrate. Am J Cardiovasc Drugs 2009;9:7-15.
43.
Munzel T, Daiber A, Gori T: More answers to the still unresolved question of nitrate tolerance. Eur Heart J 2013;34:2666-2673.
44.
Munzel T, Daiber A, Gori T: Nitrate therapy: new aspects concerning molecular action and tolerance. Circulation 2011;123:2132-2144.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.