PT  - JOURNAL ARTICLE
AU  - David Montani
AU  - Fabrice Antigny
AU  - Etienne-Marie Jutant
AU  - Marie-Camille Chaumais
AU  - Hélène Le Ribeuz
AU  - Julien Grynblat
AU  - Charles Khouri
AU  - Marc Humbert
TI  - Pulmonary hypertension associated with diazoxide: the SUR1 paradox
AID  - 10.1183/23120541.00350-2023
DP  - 2023 Nov 01
TA  - ERJ Open Research
PG  - 00350-2023
VI  - 9
IP  - 6
4099  - http://openres.ersjournals.com/content/9/6/00350-2023.short
4100  - http://openres.ersjournals.com/content/9/6/00350-2023.full
SO  - erjor2023 Nov 01; 9
AB  - The ATP-sensitive potassium channels and their regulatory subunits, sulfonylurea receptor 1 (SUR1/Kir6.2) and SUR2/Kir6.1, contribute to the pathophysiology of pulmonary hypertension (PH). Loss-of-function pathogenic variants in the ABCC8 gene, which encodes for SUR1, have been associated with heritable pulmonary arterial hypertension. Conversely, activation of SUR1 and SUR2 leads to the relaxation of pulmonary arteries and reduces cell proliferation and migration. Diazoxide, a SUR1 activator, has been shown to alleviate experimental PH, suggesting its potential as a therapeutic option. However, there are paradoxical reports of diazoxide-induced PH in infants. This review explores the role of SUR1/2 in the pathophysiology of PH and the contradictory effects of diazoxide on the pulmonary vascular bed. Additionally, we conducted a comprehensive literature review of cases of diazoxide-associated PH and analysed data from the World Health Organization pharmacovigilance database (VigiBase). Significant disproportionality signals link diazoxide to PH, while no other SUR activators have been connected with pulmonary vascular disease. Diazoxide-associated PH seems to be dose-dependent and potentially related to acute effects on the pulmonary vascular bed. Further research is required to decipher the differing pulmonary vascular consequences of diazoxide in different age populations and experimental models.The activation of SUR1 and SUR2 is beneficial in experimental models of PH. Paradoxically, the SUR1 activator, diazoxide, leads to cases of PAH in children. Further investigation is needed. https://bit.ly/462KdG7