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Rho kinase inhibition on renal remodeling in an apatinib-induced hypertensive rat model. J Hypertens 2022; 40:1838-1840. [PMID: 35943108 DOI: 10.1097/hjh.0000000000003184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The counter-regulatory arm of the renin-angiotensin system and COVID-19: insights from Gitelman's and Bartter's syndromes. J Hypertens 2022; 40:648-649. [PMID: 35165247 DOI: 10.1097/hjh.0000000000003090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rho Kinase Activity, Connexin 40, and Atrial Fibrillation: Mechanistic Insights from End-Stage Renal Disease on Dialysis Patients. J Clin Med 2020; 9:jcm9010165. [PMID: 31936157 PMCID: PMC7019687 DOI: 10.3390/jcm9010165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022] Open
Abstract
Evidence on cellular/molecular mechanisms leading to atrial fibrillation (AF) are scanty. Increased expression of Rho kinase (ROCK) and myosin-phosphatase-target subunit-1 (MYPT-1), ROCK activity’s marker, were shown in AF patients, which correlated with connexin 40 (Cx40) expression, membrane protein of heart gap junctions, key for rapid action potential’s cell–cell transfer. AF is the most frequent arrhythmia in dialysis patients who present increased MYPT-1 phosphorylation, which correlates with left ventricular (LV) mass. Given ROCK’s established role in cardiovascular–renal remodeling, induction of impaired cell-to-cell coupling/potential conduction promoting AF initiation/perpetuation, we evaluated in dialysis patients with AF, MYPT-1 phosphorylation, Cx40 expression, and their relationships to support their involvement in AF. Mononuclear cells’ MYPT-1 phosphorylation, Cx40 expression, and the ROCK inhibitor fasudil’s effect were assessed in dialysis patients with AF (DPAFs), dialysis patients with sinus rhythm (DPs), and healthy subjects (C) (western blot). M-mode echocardiography assessed LV mass and left atrial systolic volume. DPAF’s phospho-MYPT-1 was increased vs. that of DPs and C (1.57 ± 0.17 d.u. vs. 0.69 ± 0.04 vs. 0.51 ± 0.05 respectively, p < 0.0001). DP’s phospho-MYPT-1 was higher vs. that of C, p = 0.009. DPAF’s Cx40 was higher vs. that of DPs and C (1.23 ± 0.12 vs. 0.74 ± 0.03 vs. 0.69 ± 0.03, p < 0.0001). DPAF’s phospho-MYPT-1 correlated with Cx40 (p < 0.001), left atrial systolic volume (p = 0.013), and LV mass (p = 0.014). In DPAFs, fasudil reduced MYPT-1 phosphorylation (p < 0.01) and Cx40 expression (p = 0.03). These data point toward ROCK and Cx40’s role in the mechanism(s) leading to AF in dialysis patients. Exploration of the ROCK pathway in AF could contribute to AF generation’s mechanistic explanations and likely identify potential pharmacologic targets for translation into treatment.
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Zhong F, Ying H, Jia W, Zhou X, Zhang H, Guan Q, Xu J, Fang L, Zhao J, Xu C. Characteristics and Follow-Up of 13 pedigrees with Gitelman syndrome. J Endocrinol Invest 2019; 42:653-665. [PMID: 30413979 PMCID: PMC6531408 DOI: 10.1007/s40618-018-0966-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Gitelman syndrome (GS) is clinically heterogeneous. The genotype and phenotype correlation has not been well established. Though the long-term prognosis is considered to be favorable, hypokalemia is difficult to cure. OBJECTIVE To analyze the clinical and genetic characteristics and treatment of all members of 13 GS pedigrees. METHODS Thirteen pedigrees (86 members, 17 GS patients) were enrolled. Symptoms and management, laboratory findings, and genotype-phenotype associations among all the members were analyzed. RESULTS The average ages at onset and diagnosis were 27.6 ± 10.2 years and 37.9 ± 11.6 years, respectively. Males were an average of 10 years younger and exhibited more profound hypokalemia than females. Eighteen mutations were detected. Two novel mutations (p.W939X, p.G212S) were predicted to be pathogenic by bioinformatic analysis. GS patients exhibited the lowest blood pressure, serum K+, Mg2+, and 24-h urinary Ca2+ levels. Although blood pressure, serum K+ and Mg2+ levels were normal in heterozygous carriers, 24-h urinary Na+ excretion was significantly increased. During follow-up, only 41.2% of patients reached a normal serum K+ level. Over 80% of patients achieved a normal Mg2+ level. Patients were taking 2-3 medications at higher doses than usual prescription to stabilize their K+ levels. Six patients were taking spironolactone simultaneously, but no significant elevation in the serum K+ level was observed. CONCLUSION The phenotypic variability of GS and therapeutic strategies deserve further research to improve GS diagnosis and prognosis. Even heterozygous carriers exhibited increased 24-h Na+ urine excretion, which may make them more susceptible to diuretic-induced hypokalemia.
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Affiliation(s)
- F Zhong
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - H Ying
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - W Jia
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - X Zhou
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - H Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - Q Guan
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - J Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - L Fang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China
| | - J Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China.
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China.
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China.
| | - C Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Jinan, 250021, Shandong, China.
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, 250021, Shandong, China.
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, Shandong, China.
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Ravarotto V, Simioni F, Sabbadin C, Pagnin E, Maiolino G, Armanini D, Calò LA. Proinflammatory/profibrotic effects of aldosterone in Gitelman's syndrome, a human model opposite to hypertension. J Endocrinol Invest 2019; 42:521-526. [PMID: 30136149 DOI: 10.1007/s40618-018-0942-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Aldosterone proinflammatory/profibrotic effects are mediated by the induction of mononuclear leucocytes (MNL) to express oxidative stress (OxSt)-related proteins, such as p22phox, and by the activation of RhoA/Rho kinase pathway. Gitelman's syndrome (GS), an autosomal recessive tubulopathy, is an interesting opposite model to hypertension, being characterized by hypokalemia, activation of renin-angiotensin-aldosterone system yet normo/hypotension and lack of cardiovascular-renal remodeling. We aimed to evaluate the proinflammatory/profibrotic effect of aldosterone in MNL of 6 GS patients compared with 6 healthy subjects (HS). METHODS p22phox expression and MYPT-1 phosphorylation status, a marker of RhoA/Rho kinase pathway activation, were evaluated in MNL of GS patients and HS at baseline and after incubation with aldosterone (1 × 10-8 M) alone or with canrenone (1 × 10-6 M). RESULTS At basal condition, p22phox expression was significantly higher in HS than in GS patients (1.02 ± 0.05 densitometric unit (du) vs 0.40 ± 0.1 du, respectively). Aldosterone significantly increased p22phox expression in HS and this effect was reversed by coincubation with canrenone (1.4 ± 0.05 du and 1.09 ± 0.03 du, respectively). No significant change was reported in GS after incubation of MNL with aldosterone and/or canrenone compared with basaline. Even MYPT-1 phosphorylation was significantly higher in HS compared with GS patients at basal condition (1.16 ± 0.1 du vs 0.69 ± 0.07, respectively). Aldosterone significantly increased MYPT-1 phosphorylation only in HS (1.37 ± 0.1 du vs 0.83 ± 0.12 du in GS). CONCLUSIONS GS patients seem to be protected by the OxSt status induced by aldosterone and revealed in HS. This human model could provide additional clues to highlight the proinflammatory/cardiovascular remodeling effects of aldosterone.
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Affiliation(s)
- V Ravarotto
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - F Simioni
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - C Sabbadin
- Department of Medicine-Endocrinology, University of Padova, Padua, Italy
| | - E Pagnin
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - G Maiolino
- Department of Medicine-Hypertension, University of Padova, Padua, Italy
| | - D Armanini
- Department of Medicine-Endocrinology, University of Padova, Padua, Italy
| | - L A Calò
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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Ravarotto V, Carraro G, Pagnin E, Bertoldi G, Simioni F, Maiolino G, Martinato M, Landini L, Davis PA, Calò LA. Oxidative stress and the altered reaction to it in Fabry disease: A possible target for cardiovascular-renal remodeling? PLoS One 2018; 13:e0204618. [PMID: 30261035 PMCID: PMC6160124 DOI: 10.1371/journal.pone.0204618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Fabry disease is characterized by deficient expression/activity of α-GalA with consequent lysosomal accumulation in various organs of its substrate Gb3. Despite enzyme replacement therapy, Fabry disease progresses with serious myocardial, cerebral and renal manifestations. Gb3 accumulation may induce oxidative stress (OxSt), production of inflammatory cytokines and reduction of nitric oxide, which may impact on Fabry disease's clinical manifestations. METHODS OxSt status was characterized in 10 patients compared with 10 healthy subjects via protein expression of p22phox, subunit of NADH/NADPH oxidase, (Western blot), Heme oxygenase (HO)-1 levels (ELISA), antioxidant/anti-inflammatory, lipid peroxidation as malondialdehyde (MDA) production (colorimetric assay), phosphorylation state of Extracellular Signal Regulated Kinase (ERK)1/2 and Myosin Phosphatase Target Protein (MYPT)-1 (Western blot), marker of Rho kinase activation, both involved in OxSt signaling. Cardiac left ventricular (LV) mass was also evaluated (M-mode echocardiography). RESULTS LV mass was higher in Fabry's males (123.72±2.03SEM g/m2) and females (132.09±6.72g/m2). p22phox expression was also higher in patients (1.04±0.09 d.u. vs 0.54±0.05 d.u. p<0.01) as well as MDA levels (54.51±3.97 vs 30.05±7.11 nmol/mL p = 0.01) while HO-1 was reduced (8.84±0.79 vs 14.03±1.23 ng/mL, p<0.02). MYPT-1's phosphorylation was increased in patients (0.52±0.11 d.u. vs 0.03±0.08 d.u., p<0.01) while phosphorylation of ERK1/2 was reduced (0.91±0.08 d.u. vs 1.53±0.17 d.u., p = 0.004). CONCLUSIONS This study documents OxSt activation and the altered reaction to it in Fabry patients. Cardiac remodeling, Rho kinase signaling activation and reduction of protective HO-1 might suggest that, in addition to enzyme replacement therapy, OxSt inhibition by either pharmacological or nutritional measures, is likely to prove useful for the prevention/treatment of Fabry patients' cardiovascular-renal remodeling.
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Affiliation(s)
| | - Gianni Carraro
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Elisa Pagnin
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Giovanni Bertoldi
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Francesca Simioni
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Giuseppe Maiolino
- Department of Medicine, Hypertension, University of Padua, Padua Italy
| | | | | | - Paul A Davis
- Department of Nutrition, University of California, Davis, United States of America
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padua, Padua Italy
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Abstract
Hypertensive kidney disease classically entails nephroangiosclerosis and hyalinosis with glomerular damage. However, in recent years, several evidences showed that high blood pressure also injures tubular cells, inducing epithelial-to-mesenchymal transition and tubulointerstitial fibrosis. Recently investigated mechanisms are also podocyte effacement and loss, which lead to denudation of the glomerular basement membrane and focal adhesion of the tufts to the Bowman's capsule, with reduced filtration and scars. Starting from the classic concept of nephroangiosclerosis, this review examines the recently emerged knowledge of new biochemical and molecular mechanisms underlying the kidney damage in hypertension and discusses how viable podocytes or podocyte-deriving proteins are promising tools for early diagnosis of renal remodelling in hypertension.
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Düsing R. Pharmacological interventions into the renin-angiotensin system with ACE inhibitors and angiotensin II receptor antagonists: effects beyond blood pressure lowering. Ther Adv Cardiovasc Dis 2016; 10:151-61. [PMID: 27122491 DOI: 10.1177/1753944716644130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hypertension is recognized as an important risk factor for cardiovascular morbidity and mortality. Lowering of blood pressure has been shown to minimize the risk of cardiovascular events, with the majority of antihypertensives demonstrating a similar ability to reduce coronary events and stroke for a given reduction in blood pressure. Agents that modify the activity of the renin-angiotensin system (RAS) have been proposed to exhibit additional effects that might go beyond simple blood pressure lowering. The RAS is a crucial system that regulates extracellular fluid volume and blood pressure. Proposed potential benefits of RAS blockade that go beyond blood pressure lowering include a reduction in platelet aggregation and thrombosis, blunting of cardiac and vascular remodeling, favorable metabolic effects and reno- and cerebro-protection. However, factors such as treatment adherence, duration of action of antihypertensive agents and differences in effects on central versus brachial blood pressure may also result in apparent differences in efficacy of different antihypertensives. The aim of this review article is to examine the available data from clinical studies of antihypertensive drugs for evidence of effects that might legitimately be claimed to go beyond simple blood pressure lowering.
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Affiliation(s)
- Rainer Düsing
- Hypertoniezentrum Bonn, Am Burgweiher 52-54, 53123 Bonn, Germany
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Maiolino G, Pagnin E, Plebani M, Davis PA, Calò LA. Uric acid and cardiovascular-renal disease risk. Insights from a human model opposite to hypertension. Int J Cardiol 2016; 212:18-9. [PMID: 27016704 DOI: 10.1016/j.ijcard.2016.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/02/2016] [Accepted: 03/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Elisa Pagnin
- Department of Medicine, Nephrology, University of Padova, Italy
| | - Mario Plebani
- Department of Medicine, Laboratory Medicine University of Padova, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, USA
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padova, Italy.
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Calò LA, Vertolli U, Pagnin E, Ravarotto V, Davis PA, Lupia M, Naso E, Maiolino G, Naso A. Increased rho kinase activity in mononuclear cells of dialysis and stage 3-4 chronic kidney disease patients with left ventricular hypertrophy: Cardiovascular risk implications. Life Sci 2016; 148:80-5. [PMID: 26872982 DOI: 10.1016/j.lfs.2016.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/22/2016] [Accepted: 02/06/2016] [Indexed: 11/19/2022]
Abstract
AIMS Cardiovascular disease (CVD) is the leading cause of excess mortality in chronic kidney disease (CKD) and dialysis patients (DP) who have higher prevalence of left ventricular hypertrophy (LVH), the strongest predictor of CV events. Rho kinase (ROCK) activation is linked in hypertensive patients to cardiac remodeling while ROCK inhibition suppresses cardiomyocyte hypertrophy and, in a human clinical condition opposite to hypertension, its downregulation associates with lack of CV remodeling. Information on ROCK activation-LVH link in CKD and DP is lacking. MATERIALS AND METHODS Mononuclear cells (PBMCs) MYPT-1 phosphorylation, a marker of ROCK activity, and the effect of fasudil, a ROCK inhibitor, on MYPT-1 phosphorylation were assessed in 23 DPs, 13 stage 3-4 CKD and 36 healthy subjects (HS) by Western blot. LV mass was assessed by M-mode echocardiography. KEY FINDINGS DP and CKD had higher MYPT-1 phosphorylation compared to HS (p<0.001 and p=0.003). Fasudil (500 and 1000μM) dose dependently reduced MYPT-1 phosphorylation in DP (p<0.01). DP had higher LV mass than CKD (p<0.001). MYPT-1 phosphorylation was higher in patients with LVH (p=0.009) and correlated with LV mass both in DP and CKD with LVH (p<0.001 and p=0.006). SIGNIFICANCE In DP and CKD, ROCK activity tracks with LVH. This ROCK activation-LVH link provided in these CVD high-risk patients along with similar findings in hypertensive patients and added to opposite findings in a human model opposite to hypertension and in type 2 diabetic patients, identify ROCK activation as a potential LVH marker and provide further rationale for ROCK activation inhibition as target of therapy in CVD high-risk patients.
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Affiliation(s)
- Lorenzo A Calò
- Department of Medicine (DIMED), Nephrology, University of Padova, Italy.
| | - Ugo Vertolli
- Department of Medicine (DIMED), Nephrology, University of Padova, Italy
| | - Elisa Pagnin
- Department of Medicine (DIMED), Nephrology, University of Padova, Italy
| | | | - Paul A Davis
- Department of Nutrition, University of California, Davis, USA
| | - Mario Lupia
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Elena Naso
- Department of Medicine (DIMED), Nephrology, University of Padova, Italy
| | - Giuseppe Maiolino
- Department of Medicine (DIMED), Hypertension, University of Padova, Italy
| | - Agostino Naso
- Department of Medicine (DIMED), Nephrology, University of Padova, Italy
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Calò LA, Maiolino G. Hypomagnesaemia, cardiovascular–renal negative effects and Gitelman's syndrome: A paradox awaiting resolution. Int J Cardiol 2015; 198:106-7. [DOI: 10.1016/j.ijcard.2015.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 06/26/2015] [Indexed: 11/30/2022]
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Maiolino G, Azzolini M, Rossi GP, Davis PA, Calò LA. Bartter/Gitelman syndromes as a model to study systemic oxidative stress in humans. Free Radic Biol Med 2015; 88:51-8. [PMID: 25770663 DOI: 10.1016/j.freeradbiomed.2015.02.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 02/07/2023]
Abstract
Reactive oxygen species (ROS) are intermediates in reduction-oxidation reactions that begin with the addition of one electron to molecular oxygen, generating the primary ROS superoxide, which in turn interacts with other molecules to produce secondary ROS, such as hydrogen peroxide, hydroxyl radical, and peroxynitrite. ROS are continuously produced during metabolic processes and are deemed to play an important role in cardiovascular diseases, namely, myocardial hypertrophy and fibrosis and atherosclerosis, via oxidative damage of lipids, proteins, and deoxyribonucleic acid. Angiotensin II (Ang II) is a potent vasoactive agent that also exerts mitogenic, proinflammatory, and profibrotic effects through several signaling pathways, in part involving ROS, particularly superoxide and hydrogen peroxide. Moreover, Ang II stimulates NADPH oxidases, leading to higher ROS generation and oxidative stress. Bartter/Gitelman syndrome patients, despite elevated plasma renin activity, Ang II, and aldosterone levels, exhibit reduced peripheral resistance, normal/low blood pressure, and blunted pressor effect of vasoconstrictors. In addition, notwithstanding the activation of the renin-angiotensin system and the increased plasma levels of Ang II, these patients display decreased production of ROS, reduced oxidative stress, and increased antioxidant defenses. In fact, Bartter/Gitelman syndrome patients are characterized by reduced levels of p22(phox) gene expression and undetectable plasma peroxynitrite levels, while showing increased plasma antioxidant power and expression of antioxidant enzymes, such as heme oxygenase-1. In conclusion, multifarious data suggest that Bartter and Gitelman syndrome patients are a model of low oxidative stress and high antioxidant defenses. The contribution offered by the study of these syndromes in elucidating the molecular mechanisms underlying this favorable status could offer chances for new therapeutic targets in disease characterized by high levels of reactive oxygen species.
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Affiliation(s)
- Giuseppe Maiolino
- Nephrology and Hypertension Clinic, Department of Medicine, University of Padova, 35126 Padova, Italy
| | - Matteo Azzolini
- Nephrology and Hypertension Clinic, Department of Medicine, University of Padova, 35126 Padova, Italy
| | - Gian Paolo Rossi
- Nephrology and Hypertension Clinic, Department of Medicine, University of Padova, 35126 Padova, Italy
| | - Paul A Davis
- Department of Nutrition, University of California at Davis, Davis, CA 95616, USA
| | - Lorenzo A Calò
- Nephrology and Hypertension Clinic, Department of Medicine, University of Padova, 35126 Padova, Italy.
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Calò LA, Davis PA, Maiolino G, Pagnin E, Ravarotto V, Naso E, Carraro G, Naso A. Assessing the Relationship of Angiotensin II Type 1 Receptors with Erythropoietin in a Human Model of Endogenous Angiotensin II Type 1 Receptor Antagonism. Cardiorenal Med 2015; 6:16-24. [PMID: 27194993 DOI: 10.1159/000439183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/28/2015] [Indexed: 12/26/2022] Open
Abstract
HYPOTHESIS/INTRODUCTION Angiotensin II (Ang II) has been shown to control erythropoietin (EPO) synthesis as Ang II type 1 receptor (AT1R) blockers block Ang-II-induced EPO oversecretion. To further explore the involvement of AT1R in processes controlling EPO levels, plasma EPO and mononuclear cell NADPH oxidase 4 (NOX4) - a NOX family member involved in oxygen sensing, which is a process central to controlling EPO levels - were assessed in Bartter's/Gitelman's syndrome (BS/GS) patients, a human model of endogenous AT1R antagonism and healthy subjects. Heme oxygenase (HO)-1, antioxidant and anti-inflammatory factor related to NOX4 activation, and the relationship of EPO and NOX4 to HO-1 were also assessed. MATERIALS AND METHODS EPO was measured by chemiluminescent immunoassay, HO-1 by sandwich immunoassay and NOX4 protein expression by Western blot. RESULTS EPO was increased in BS/GS patients compared to healthy subjects (7.64 ± 2.47 vs. 5.23 ± 1.07 U/l; p = 0.025), whereas NOX4 did not differ between BS/GS and healthy subjects (1.76 ± 0.61 vs. 1.65 ± 0.54 densitometric units; p = n.s.), and HO-1 was increased in BS/GS patients compared to healthy subjects (9.58 ± 3.07 vs. 5.49 ± 1.04 ng/ml; p = 0.003). NOX4 positively correlated with HO-1 only in BS/GS patients; no correlation was found between EPO and either NOX4 or HO-1 in those two groups. CONCLUSIONS The effect of the renin-angiotensin system on EPO cannot be solely mediated by Ang II via AT1R signaling, but rather, EPO levels are also determined by a complex interrelated set of signals that involve AT2R, nitric oxide levels, NOX4 and HO-1 activity.
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Affiliation(s)
- Lorenzo A Calò
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, Calif., USA
| | - Giuseppe Maiolino
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Elisa Pagnin
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Verdiana Ravarotto
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Elena Naso
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Gianni Carraro
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Agostino Naso
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
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Ravarotto V, Pagnin E, Maiolino G, Fragasso A, Carraro G, Rossi B, Calò LA. The blocking of angiotensin II type 1 receptor and RhoA/Rho kinase activity in hypertensive patients: Effect of olmesartan medoxomil and implication with cardiovascular-renal remodeling. J Renin Angiotensin Aldosterone Syst 2015; 16:1245-50. [DOI: 10.1177/1470320315594324] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- Verdiana Ravarotto
- Department of Medicine Nephrology, University of Padova-Azienda Ospedaliera Padova, Italy
- Hypertension Clinic, University of Padova-Azienda Ospedaliera Padova, Italy
| | - Elisa Pagnin
- Department of Medicine Nephrology, University of Padova-Azienda Ospedaliera Padova, Italy
| | - Giuseppe Maiolino
- Hypertension Clinic, University of Padova-Azienda Ospedaliera Padova, Italy
| | - Antonio Fragasso
- Department of Medicine Nephrology, University of Padova-Azienda Ospedaliera Padova, Italy
| | - Gianni Carraro
- Department of Medicine Nephrology, University of Padova-Azienda Ospedaliera Padova, Italy
| | - Barbara Rossi
- Department of Medicine Nephrology, University of Padova-Azienda Ospedaliera Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine Nephrology, University of Padova-Azienda Ospedaliera Padova, Italy
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