Effect of amiloride analogues on sodium transport in renal brush border membrane vesicles from Milan hypertensive rats

Personalized Therapy of Hypertension: the Past and the Future

During the past 20 years, the studies on genetics or pharmacogenomics of primary hypertension provided interesting results supporting the role of genetics, but no actionable finding ready to be translated into personalized medicine. Two types of approaches have been applied: a "hypothesis-driven" approach on the candidate genes, coding for proteins involved in the biochemical machinery underlying the regulation of BP, and an "unbiased hypothesis-free" approach with GWAS, based on the randomness principles of frequentist statistics. During the past 10-15 years, the application of the latter has overtaken the application of the former leading to an enlargement of the number of previously unknown candidate loci or genes but without any actionable result for the therapy of hypertension. In the present review, we summarize the results of our hypothesis-driven approach based on studies carried out in rats with genetic hypertension and in humans with essential hypertension at the pre-hypertensive and early hypertensive stages. These studies led to the identification of mutant adducin and endogenous ouabain as candidate genetic-molecular mechanisms in both species. Rostafuroxin has been developed for its ability to selectively correct Na(+) pump abnormalities sustained by the two abovementioned mechanisms and to selectively reduce BP in rats and in humans carrying the gene variants underlying the mutant adducin and endogenous ouabain (EO) effects. A clinical trial is ongoing to substantiate these findings. Future studies should apply both the candidate gene and GWAS approaches to fully exploit the potential of genetics in optimizing the personalized therapy.

Na+/H+ exchangers: physiology and link to hypertension and organ ischemia

PURPOSE OF REVIEW

Na/H exchangers (NHEs) are ubiquitous proteins with a very wide array of physiological functions, and they are summarized in this paper in view of the most recent advances. Hypertension and organ ischemia are two disease states of paramount importance in which NHEs have been implicated. The involvement of NHEs in the pathophysiology of these disorders is incompletely understood. This paper reviews the principal findings and current hypotheses linking NHE dysfunction to hypertension and ischemia.

RECENT FINDINGS

With the advent of large-scale sequencing projects and powerful in-silico analyses, we have come to know what is most likely the entire mammalian NHE gene family. Recent advances have detailed the roles of NHE proteins, exploring new functions such as anchoring, scaffolding and pH regulation of intracellular compartments. Studies of NHEs in disease models, even though not conclusive to date, have contributed new evidence on the interplay of ion transporters and the delicate ion balances that may become disrupted.

SUMMARY

This paper provides the interested reader with a concise overview of NHE physiology, and aims to address the implication of NHEs in the pathophysiology of hypertension and organ ischemia in light of the most recent literature.

Genetic and biochemical determinants of abnormal monovalent ion transport in primary hypertension

Data obtained during the last two decades show that spontaneously hypertensive rats, an acceptable experimental model of primary human hypertension, possess increased activity of both ubiquitous and renal cell-specific isoforms of the Na+/H+ exchanger (NHE) and Na+-K+-2Cl- cotransporter. Abnormalities of these ion transporters have been found in patients suffering from essential hypertension. Recent genetic studies demonstrate that genes encoding the beta- and gamma-subunits of ENaC, a renal cell-specific isoform of the Na+-K+-2Cl- cotransporter, and alpha3-, alpha1-, and beta2-subunits of the Na+-K+ pump are localized within quantitative trait loci (QTL) for elevated blood pressure as well as for enhanced heart-to-body weight ratio, proteinuria, phosphate excretion, and stroke latency. On the basis of the homology of genome maps, several other genes encoding these transporters, as well as the Na+/H+ exchanger and Na+-K+-2Cl- cotransporter, can be predicted in QTL related to the pathogenesis of hypertension. However, despite their location within QTL, analysis of cDNA structure did not reveal any mutation in the coding region of the above-listed transporters in primary hypertension, with the exception of G276L substitution in the alpha1-Na+-K+ pump from Dahl salt-sensitive rats and a higher occurrence of T594M mutation of beta-ENaC in the black population with essential hypertension. These results suggest that, in contrast to Mendelian forms of hypertension, the altered activity of monovalent ion transporters in primary hypertension is caused by abnormalities of systems involved in the regulation of their expression and/or function. Further analysis of QTL in F2 hybrids of normotensive and hypertensive rats and in affected sibling pairs will allow mapping of genes causing abnormalities of these regulatory pathways.

Transport of exogenous 5-hydroxytryptamine across the outer plasma membrane of the syncytial tegument ofHymenolepis diminutais by simple diffusion

The uptake of 5-hydroxytryptamine (5HT) from a 10 μM solution of exogenous [3H]5HT into the tegument of Hymenolepis diminuta was linear for the first 20 min of incubation. The rate of transport was 0.04 ± 0.01 pmol∙mg wet mass−1∙min−1, and there were no significant differences in the rate of uptake by the anterior, middle, and posterior regions of the body. The initial uptake was not Na+-dependent, was not saturable at up to 100 μM, was not highly temperature-dependent (Q10~ 1.2), and displayed activation energy of 11.8 kJ∙mol−1. Furthermore, uptake was not inhibited by p-chloromercuriphenyl sulphonic acid, imipramine, amiloride, or 5HT analogues, which collectively support a non-carrier-mediated uptake mechanism. Washing of the tissues with 10 mM 5HT after incubation in 10 μM [3H]5HT displaced less than 10% of the remaining [3H]5HT associated with the tissues, and little radioactivity was extracted by washing in acetone or chloroform. The uptake of [3H]5HT, however, was pH-dependent, the rate of uptake being closely correlated with the proportion of unprotonated 5HT. Only a small portion of the transported [3H]5HT was metabolized to a product associated with 5-hydroxyindoleacetic acid, and metabolism was significantly inhibited by the monoamine oxidase inhibitors iproniazid phosphate, deprenyl, and clorgyline. The present study showed that small amounts of [3H]5HT were taken up by H. diminuta by simple diffusion, little of the [3H]5HT was adsorbed to the surface of the worms or dissolved in the lipid phase of the plasma membrane, and some of the [3H]5HT taken up was metabolized by a monoamine oxidase-like enzyme.