{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T09:34:03Z","timestamp":1768988043905,"version":"3.49.0"},"reference-count":64,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100021708","name":"New South Wales Government","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bpspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["British J Pharmacology"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>Hydroxychloroquine, chloroquine and azithromycin are three drugs that were proposed to treat coronavirus disease 2019 (COVID\u201019). While concern already existed around their proarrhythmic potential, there are little data regarding how altered physiological states encountered in patients such as febrile state, electrolyte imbalances or acidosis might change their risk profiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Experimental Approach<\/jats:title><jats:p>Potency of human ether\u2010\u00e0\u2010go\u2010go related gene (hERG) block was measured using high\u2010throughput electrophysiology in the presence of variable environmental factors. These potencies informed simulations to predict population risk profiles. Effects on cardiac repolarisation were verified in human induced pluripotent stem cell\u2010derived cardiomyocytes from multiple individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Chloroquine and hydroxychloroquine blocked hERG with IC<jats:sub>50<\/jats:sub> of 1.47\u2009\u00b1\u20090.07 and 3.78\u2009\u00b1\u20090.17\u2009\u03bcM, respectively, indicating proarrhythmic risk at concentrations effective against severe acute respiratory syndrome\u2010coronovirus\u20102 (SARS\u2010CoV\u20102) in vitro. Hypokalaemia and hypermagnesaemia increased potency of chloroquine and hydroxychloroquine, indicating increased proarrhythmic risk. Acidosis significantly reduced potency of all drugs, whereas increased temperature decreased potency of chloroquine and hydroxychloroquine against hERG but increased potency for azithromycin. In silico simulations demonstrated that proarrhythmic risk was increased by female sex, hypokalaemia and heart failure and identified specific genetic backgrounds associated with emergence of arrhythmia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion and Implications<\/jats:title><jats:p>Our study demonstrates how proarrhythmic risk can be exacerbated by metabolic changes and pre\u2010existing disease. More broadly, the study acts as a blueprint for how high\u2010throughput in vitro screening, combined with in silico simulations, can help guide both preclinical screening and clinical management of patients in relation to drugs with potential to prolong repolarisation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bph.15757","type":"journal-article","created":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T01:38:32Z","timestamp":1637977112000},"page":"2631-2646","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Pathophysiological metabolic changes associated with disease modify the proarrhythmic risk profile of drugs with potential to prolong repolarisation"],"prefix":"10.1111","volume":"179","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9696-0166","authenticated-orcid":false,"given":"Clifford","family":"TeBay","sequence":"first","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey R.","family":"McArthur","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"Illawarra Health and Medical Research Institute University of Wollongong  Wollongong New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Mangala","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"St. Vincent's Clinical School UNSW Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Kerr","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"St. Vincent's Clinical School UNSW Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stewart","family":"Heitmann","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew D.","family":"Perry","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"School of Medical Sciences UNSW Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique J.","family":"Windley","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"St. Vincent's Clinical School UNSW Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie I.","family":"Vandenberg","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"St. Vincent's Clinical School UNSW Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6403-1282","authenticated-orcid":false,"given":"Adam P.","family":"Hill","sequence":"additional","affiliation":[{"name":"Molecular Cardiology and Biophysics Victor Chang Cardiac Research Institute  Sydney New South Wales Australia"},{"name":"St. Vincent's Clinical School UNSW Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"issue":"1","key":"e_1_2_13_2_1","first-page":"S157","article-title":"The Concise Guide to PHARMACOLOGY 2021\/22: Ion channels","volume":"178","author":"Alexander S. 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