A Hopeful Prospect of Riociguat as a Soluble Guanylate Cyclase Stimulator for Management of Pressure Ulcers.

Abstract

Pressure ulcer remains as a common problem, especially developed in disabled patients and hence, subjected to continuous pressure for prolonged periods of time. Most of the studies investigating the preventive and therapeutic approaches have focused on wound cleansing, dressing and supportive strategies, as well as pharmacological therapy including zinc sulphate, vitamin A or phenytoin. Despite such efforts, pressure ulcer continues to impair the life quality and expectancy. Thus involving in the paradigm shift in biomedical studies, the recent ones focus on biological signaling pathways involving nitric oxide (NO)- soluble guanylatecyclase (sGC)- cyclic guanosine monophosphate (cGMP) contributing in vasodilation, reperfusion and oxygen delivery. Literatures review focusing on NO/sGC/cGMP pathway was performed as well as seeking themolecular biology aspects inKyoto Encyclopedia of genes and genomes (KEGG). NO is an important signaling molecule activating sGC and cGMP production, which is a mediator of vasodilation and platelet inhibition. Considering the subject, it could be hypothesized that the application of sGC stimulators and activators is a very curious strategy for pressure ulcer healing. It is well known that pressure and shear forces usually produce the blood vessel obstruction, inducing ischemia and tissue necrosis and in pathologic states, damaged endothelium leads to a reduced synthesis of NO and inadequate oxygen supply contributing to delayed wound healing. Riociguat is the first FDA approved agent of new class of sGC stimulators, involving in activation of sGC both in presence and absence of NO. The findings of this review confirm that Riociguat could start a new therapeutic approach for pressure ulcer treatment even with dysfunctional endothelium.