1 The vascular effects of cicletanine have been studied in vitro on ring preparations of inferior epigastric arteries from normotensive human females and human females with pregnancy-induced hypertension (preeclampsia). 2 Cicletanine (10--1iO-3M) elicited concentration-dependent relaxation of vessels precontracted with 1-07M noradrenaline (NA) or 60 mm K+ but was more potent in the former. Relaxation was significantly greater in rings from preeclamptic patients and was uninfluenced by endothelium removal. 3 The intracellular Ca-dependent contractile responses to 10-5M NA in Ca-free medium as well as the subsequent extracellular Ca-dependent contractions (on restoration of external Ca) were significantly attenuated dose-dependently by cicletanine (10-5M, 3 x 1O-4M) in arterial rings from both normotensive and preeclamptic patients. Cicletanine also relaxed rings precontracted by 25 mm K+ but was ineffective against 80 mm K+-induced contractions. 4 The inhibition of intracellular Ca-dependent contractions was significantly greater in rings from preeclamptic than from normotensive patients whereas extracellular Ca-dependent contractions were comparably inhibited in both groups. Nifedipine, on the other hand, had little effect on the intracellular Ca-dependent contractions but significantly depressed extracellular Ca-dependent contractions. 5 Cicletanine-induced relaxation was uninfluenced by pretreatment with propranolol, ouabain, tetraethylammonium, procaine, indomethacin, cimetidine or tetrodotoxin but was antagonized by glibenclamide. 6 The results show that cicletanine inhibits contractile responses of human isolated inferior epigastric arteries by a mechanism unrelated to endothelial factors but associated with inhibition of calcium metabolism. An action of cicletanine on glibenclamide-sensitive K+ channels is also suggested. Cicletanineinduced inhibition was significantly greater in arteries from preclamptic patients.

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Cicletanine hydrochloride is a new antihypertensive molecule synthetized and studied in our laboratory. Its chemical structure is uncommon for an antihypertensive molecule; it is characterized by the presence of a furopyridine group. Cicletanine is, therefore, a member of a new family of compounds with primarily antihypertensive properties, although some of the furopyridine derivatives have also antiallergic and antiinflammatory effects.The mechanism by which cicletanine lowers blood pressure has not been definitively established, although it appears to differ from that of other classes of antihypertensive drugs. Cicletanine acts on vascular smooth muscle by increasing prostacyclin synthesis and by interacting either directly with cytosolic Ca2+ pools or indirectly through various agents capable of mobilizing intracellular Ca ' ' , e.g., histamine.Studies in animals and humans demonstrated that the antihypertensive effect of cicletanine is clearly dissociable from its renal effect, which can be seen only at highdose levels of the drug.Clinical trials have confirmed the efficacy and safety of cicletanine in the treatment of hypertension, both as monotherapy or in combination with other antihypertensive drugs. CHEMISTRYCicletanine was synthetized by Esanu et al. (9) in the research laboratories of Institute Henri Beaufour, Le Plessis-Robinson (France). It was selected from a large number of furopyridines for its specific antihypertensive activity and very low, if any, toxicity. The chemical structure of cicletanine ( HCl) : (-+ ) 3-(4-chloropheny1)-1,3dihydro-7-hydroxy-6-methyl furo[3,Cc]pyridine is shown in Fig. 1. Its chemical synthesis from 2-,2,8-trimethyl-5-formyl pyrido [ 4,3-el 1,3-dioxine has been described (9). Cicletanine HC1 has a molecular weight of 298.2. It is not soluble in 166 CICLE TANINE 167 water, but soluble in ethanol and dimethyl sulfoxide. It is a white crystalline powder with a melting point of 2 19-228°C. PHARMACOLOGY Effect on Blood PressureThe activity of cicletanine on blood pressure was evaluated in anesthetized normotensive rats and dogs and in several models of hypertensive rats: desoxycorticosterone acetate, spontaneously ( SH ) and stroke-prone spontaneously ( SH-SP) hypertensive rats and rats with stress-induced hypertension.In the anesthetized normotensive rat, cicletanine, administered orally at 100 and 300 mg/kg, did not affect either mean blood pressure or heart rate. The blood pressure effects of epinephrine, norepinephrine, acetylcholine, isoproterenol, or serotonin were not altered by pretreatment with cicletanine.The effect of intravenously injected cicletanine on the main hemodynamic cardiovascular parameters-systolic and diastolic aortic pressure, heart rate, aortic blood flow, coronary (circumflex artery) and femoral arterial blood flow-were studied in anesthetized normotensive dog. At doses higher than 5 mg/kg i.v., cicletanine produced only a slight and transient bradycardia, a minor reduction of systolic arterial pressure, and a brief decrease in diastolic pressure. F...

The antagonism by cicletanine of contractile responses to histamine has been examined in vitro on ring preparations of rabbit mesenteric arteries. Cicletanine (10(-8)-10(-6) M) caused a parallel rightward shift of histamine concentration response curve, with a pA2 value of 7.48 (slope = 0.89 +/- 0.19, not significantly different from unity). Histamine-induced contractions were nifedipine-sensitive and associated with cicletanine-sensitive increased 45Ca uptake. Endothelium removal resulted in enhanced contractile responses to histamine, but did not significantly modify cicletanine-induced antagonism: KB (dissociation constant) values for cicletanine antagonism in the presence or absence of endothelium were: 3.7 (+/- 0.1) X 10(-8) M and 3.6 (+/- 0.3) X 10(-8) M, respectively. Cicletanine (greater than 10(-4) M) also significantly attenuated 10 mM caffeine-induced contractions in rings exposed to Ca-free 100 mM K+ depolarizing medium. The results suggest that cicletanine-induced antagonisms of histamine H1 receptor-mediated contractions of rabbit mesenteric arteries is associated with interference with calcium entry as well as at high concentrations, release from intracellular stores.

Smooth muscle cells were cultured from guinea-pig aorta and labelled with 45Ca++ and 32Pi to investigate the possible effect of cicletanine, a new antihypertensive drug, on the release of intracellular Ca++ and the metabolism of phosphoinositide induced by histamine. In 45Ca++ labelled cells, histamine increased in a dose-dependent manner the 45Ca++ efflux in the first two minutes. Stimulation of 45Ca++ release was observed with H1-agonist [2-pyridylethylamine dihydrochloride (2-PEA)] but not with H2-agonist (dimaprit). In addition, histamine- or 2-PEA- induced 45Ca++ efflux was inhibited by the H1-antagonists (mepyramine and terfenadine) whereas the H2-antagonist (cimetidine) was without effect. Similar results were obtained in 32Pi labelled cells; both H1-agonists (histamine and 2-PEA) increased the labelling of phosphoinositides. This effect was completely blocked by mepyramine. These results demonstrate that the histamine-induced stimulation of 45Ca++ efflux and phosphoinositide metabolism are mediated through H1-receptors. In the above systems, cicletanine was as effective as the H1-antagonist (mepyramine) with an IC50 of 10(-6) M for both 45Ca++ efflux and phosphoinositide metabolism. Blockade of these systems by cicletanine may be part of the mechanism by which this drug produces relaxation of blood vessels and may account for its in vivo antihypertensive action.