THIS MONTH'S FOCUS:

PHARMACY & PHARMACOLOGY
PULMONARY HYPERTENSION

(PDF VERSION)

Many thanks to Ed Horn & Amresh Raina for coordinating the content for this month's issue.




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VINCENT'S HIDDEN SENSE


ISHLT Preliminary Program Now Available!

The 2018 ISHLT Preliminary Program is now available online in two formats:
PDF Brochure
Flip Book

Register for the:
Annual Meeting
ISHLT Academies

Submit an Abstract
Deadline:
October 24, 2017
11:59PM EST


Annual Meeting Website
Academy Website


In this issue of the Links, we are humored by contributions from Katie Watkins Dewey and Elizabeth Sarmiento on "Do These Genes Look Good On Me? Pharmacogenomics and Transplantation" and "The Pharmacology of Antibodies and Transplantation," respectively. David Salerno and Douglas L. Jennings caution us to be phlegmatic as they discuss "Right Ventricular Dysfunction After Left Ventricular Assist Device Placement and Cardiac Transplantation: Take a Deep Breath." Edward Horn and Amresh Raina channel a sanguine Shakespeare in their article "Amiodarone Exposure Prior to Heart Transplantation - Kind of a Big Deal or Much Ado About Nothing?" Thenappan Thenappan and Kurt Prins frighten us with "Evil Humors, the Right Ventricle, and Pulmonary Arterial Hypertension," and Roberto Badagliacca turns night to day for melancholy in "Right Ventricular Reverse Remodeling - Impact of Combination Therapy...From Midnight Insomnia to Clinical Practice." Enjoy!

Vincent Valentine, MD
Links Editor-in-Chief



IN THE SPOTLIGHT:


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Do These Genes Look Good On Me? Pharmacogenomics and Transplantation

Katie Watkins Dewey, PharmD, BCPS

In transplant, it is important to ensure the correct dose of medications for our patients since maintaining therapeutic levels of immunosuppression is critical to prevent rejection. Many factors play a role in managing immunosuppression, but how does a person's genetics also impact the efficacy of medications? Is there a way to optimize drug therapy and personalize medication with pharmacogenetics? What is the clinical impact of finding out that a person is an "ultra-rapid metabolizer" of a medication? The study of pharmacogenomics involves searching for targets in the genome that might influence drug responses. How effective a medication is or the likelihood of adverse effects may be driven by differences in alleles between individuals. Read more →



FOCUSING ON PHARMACY & PHARMACOLOGY:



Right Ventricular Dysfunction After Left Ventricular Assist Device Placement and Cardiac Transplantation - Take a Deep Breath

David Salerno, PharmD
Douglas L. Jennings, PharmD, FAHA, FACC

Right ventricular failure (RVF) after heart transplant (HT) or implantation of a continuous-flow left ventricular assist device (CF-LVAD) is associated with significant post-operative morbidity and mortality [1,2]. Estimates of RVF after CF-LVAD implantation and HF have been as high as 45% [3,4]. In addition to non-pharmacological modalities and intravenous vasodilators, inhaled pulmonary vasodilators are a unique treatment option aimed at minimizing systemic absorption by delivering therapy directly to the pulmonary vasculature. No formal guidelines endorse agent selection, dosing or administration of inhaled pulmonary vasodilators post-LVAD or HT. Read more →



Amiodarone Exposure Prior to Heart Transplantation - Kind of a Big Deal or Much Ado About Nothing?

Edward Horn, PharmD, BCPS, BCCCP
Amresh Raina, MD, FACC

Amiodarone use in patients awaiting heart transplantation (OHTX) has been increasingly prevalent given the frequency of atrial fibrillation (AF) as well as ventricular tachyarrhythmias in our end stage heart failure population combined with the fact that only two antiarrhythmic agents - amiodarone and dofetilide - are recommended for use in patients with heart failure with reduced ejection fraction (HFrEF) [1]. Given the choice, an overwhelming majority of patients are given amiodarone for rhythm control in AF as seen in the AF-CHF trial (> 80% patients) [2,3]. Despite the practice of ubiquitous use, amiodarone's pharmacokinetics present a challenge for patients that are awaiting OHTX. Amiodarone has a terminal half-life of nearly 6 weeks and a volume of distribution that allows it to saturate nearly every tissue in the human body. Read more →




FOCUSING ON PULMONARY HYPERTENSION:



Right Ventricular Reverse Remodeling - Impact of Combination Therapy...From Midnight Insomnia to Clinical Practice

Roberto Badagliacca, MD, PhD

Back to home after summertime, trying to induce sleep at night by looking at art online, I've been delighted by Magritte's Les Amants. Frustrated desires are a common theme in René Magritte's work. Here, a light veil prevents the intimate embrace between two lovers, transforming an act of passion into one of isolation and frustration. My drowsy mind immediately jumped to the tight association between pulmonary arterial hypertension (PAH) and the right ventricle (RV), where both untiring efforts on one side and hesitation on the other side have characterized the last two decades of research activities and debates. Many clinicians have been involved in the difficult task of facing the transition from imaging RV pathophysiology to its implementation and utilization in clinical practice. Read more →



Evil Humors, the Right Ventricle, and Pulmonary Arterial Hypertension

Kurt Prins, MD, PhD
Thenappan Thenappan, MD

Medieval medicine was based on the theory that four humors: black bile, phlegm, blood and yellow bile had to be balanced for the body to function properly and imbalance of these humors was the basis of human disease. Blood-letting was a treatment strategy implemented to restore humoral balance and remove evil humors from the body. Thankfully, our knowledge of human physiology is much more sophisticated and bloodletting, outside of polycythemia, is a treatment from the days of yore. However, inflammation may be the modern day evil humor that physicians must combat in multiple disease states. Inflammation plays a key role in pulmonary arterial hypertension (PAH) disease development and progression [1]. Read more →




ISHLT NEWS AND ANNOUNCEMENTS:



Call for Nominations - Associate Director for Pediatric Lung Transplant ISHLT Transplant Registry

The ISHLT Transplant Registry seeks nominations for an Associate Director for Pediatric Lung Transplant to work closely with Dr. Samuel Goldfarb as he completes his term as Associate Director on the Transplant Registry Steering Committee.

For detailed information on the structure and responsibilities of the ISHLT Thoracic Transplant Registry Steering Committee please see the Registry web page.

If you are interested in this position, please submit a short statement of interest along with your CV to Megan Barrett (megan.barrett@ishlt.org) by October 25, 2017.

For any questions regarding this position, please contact Dr. Sam Goldfarb (goldfarb@email.chop.edu) or Josef Stehlik (josef.stehlik@hsc.utah.edu).




SPECIAL INTEREST:



The Pharmacology of Antibodies and Transplantation

Elizabeth Sarmiento

links imageA major advance in the description of the chemical structure of antibodies was the discovery of the antibody light chain in the early 1960s by Gerald Edelman and Joseph Gally, who realized that these proteins were the same as the Bence-Jones protein described in 1845 by Henry Bence Jones. At around the same time, Rodney Porter characterized the antibody-binding (Fab) and antibody Fc regions of IgG. In 1972, the Nobel Prize in Physiology or Medicine was shared by Edelman and Porter for their discoveries on the chemical structure of antibodies. Antibodies play a dual role in heart and lung transplantation. First, they are important mediators of humoral immunity against infection. At the majority of centers, we only base our assessment of CMV infection risks on donor and recipient anti-CMV IgG status. Read more →




EDITOR'S CORNER:

From Physicians, Midwives, Apothecaries, Surgeons and Barbers to Bathmasters, Peddlers, Corn Doctors, Executioners, Knackers and Quacks for Health and Disease in the Enlightenment

Vincent Valentine, MD

links imagehttp://mikerendell.com/the-corn-doctor/

The last three Links' Issues from the Editor's Corner: 1) examined the scientific revolution which emerged from Natural Philosophy in the Renaissance (July 2017), 2) identified chemistry as a rational science distinguishing it from alchemy in the Enlightenment period (August 2017) and 3) looked at steps in developing and debunking theories through observation, experimentation and reasoning with a focused lens on the discovery of carbon dioxide and oxygen (September 2017). In this issue, we will adjust the lens on ourselves, homo sapiens, to gain a general understanding of health and disease from the 18th century with the bewildering array of medical healers and to understand how to maintain and repair our body when it gets out of balance. Read more →





Contact

Vincent G Valentine, MD
Editor-in-Chief
vvalentine@uabmc.edu


Editorial Staff


"The good thing about science is that it's true whether you believe in it or not."
— Neil deGrasse Tyson

"The caterpillar does all the work and the butterfly gets all the publicity."
— George Carlin

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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.