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Huang Y, Li T, Gao S, Li S, Zhu X, Li Y, Liu D, Li W, Yang L, Liu K, Zhang Z, Liu C. Investigating the role of NPR1 in dilated cardiomyopathy and its potential as a therapeutic target for glucocorticoid therapy. Front Pharmacol 2023; 14:1290253. [PMID: 38026943 PMCID: PMC10662320 DOI: 10.3389/fphar.2023.1290253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Dilated cardiomyopathy (DCM), a specific form of cardiomyopathy, frequently presents clinically with either left ventricular or biventricular enlargement, often leading to progressive heart failure. In recent years, the application of bioinformatics technology to scrutinize the onset, progression, and prognosis of DCM has emerged as a fervent area of interest among scholars globally. Methods: In this study, core genes closely related to DCM were identified through bioinformatics analysis, including weighted gene co expression network analysis (WGCNA) and single sample gene set enrichment analysis (ssGSEA) and so on. The correlation was verified through experiments on DCM patients, DCM rat models, and core gene knockout mice. Subsequently, the effects of glucocorticoids on DCM and the regulation of core genes were observed. Result: In the present study, natriuretic peptide receptor 1 (NPR1) was identified as a core gene associated with DCM through WGCNA and ssGSEA. Significant impairment of cardiac and renal function was observed in both DCM patients and rats, concomitant with a notable reduction in NPR1 expression. NPR1 KO mice displayed symptomatic manifestations of DCM, underscoring the pivotal role of NPR1 in its pathogenesis. Notably, glucocorticoid treatment led to substantial improvements in cardiac and renal function, accompanied by an upregulation of NPR1 expression. Discussion: These findings highlight the critical involvement of NPR1 in the pathophysiology of DCM and its potential as a key target for glucocorticoid-based DCM therapy. The study provides a robust theoretical and experimental foundation for further investigations into DCM etiology and therapeutic strategies.
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Affiliation(s)
- Yaomeng Huang
- Laboratory Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Tongxin Li
- The First Cardiology Division, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shichao Gao
- Laboratory Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shuyu Li
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, Hebei, China
| | - Xiaoran Zhu
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebeie, China
| | - Ying Li
- The First Cardiology Division, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dangyang Liu
- The First Cardiology Division, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Weimin Li
- The First Cardiology Division, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Linquan Yang
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebeie, China
| | - Kunshen Liu
- The First Cardiology Division, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zheng Zhang
- Laboratory Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chao Liu
- The First Cardiology Division, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Zhu JL, Hong L, Yuan SQ, Xu XM, Wei JR, Yin HY. Association between glucocorticoid use and all-cause mortality in critically ill patients with heart failure: A cohort study based on the MIMIC-III database. Front Pharmacol 2023; 14:1118551. [PMID: 36713831 PMCID: PMC9877223 DOI: 10.3389/fphar.2023.1118551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
Background: Heart failure (HF) is the terminal stage of various heart diseases. Conventional treatments have poor efficacy, and diuretic resistance can present. Previous studies have found that the use of glucocorticoids can enhance the diuretic effect of patients with heart failure and reduce heart failure symptoms. However, the relationship between glucocorticoid use and mortality in patients with heart failure in intensive care units is unclear. Objectives: The aim of this study was to determine the association between glucocorticoid use and all-cause mortality in critically ill patients with heart failure. Methods: The information on patients with heart failure in this study was extracted from the MIMIC-III (Medical Information Mart for Intensive Care-III) database. Patients in the glucocorticoid and non-glucocorticoid groups were matched using propensity scores. The Kaplan-Meier method was used to explore the difference in survival probability between the two groups. A Cox proportional-hazards regression model was used to analyze the hazard ratios (HRs) for the two patient groups. Subgroup analyses were performed with prespecified stratification variables to demonstrate the robustness of the results. Results: The study included 9,482 patients: 2,099 in the glucocorticoid group and 7,383 in the non-glucocorticoid group. There were 2,055 patients in each group after propensity-score matching. The results indicated that the non-glucocorticoid group was not significantly associated with reduced mortality in patients with heart failure during the 14-day follow-up period [HRs = .901, 95% confidence interval (CI) = .767-1.059]. During the follow-up periods of 15-30 and 15-90 days, the mortality risk was significantly lower in the non-glucocorticoid group than in the glucocorticoid group (HRs = .497 and 95% CI = .370-.668, and HRs = .400 and 95% CI = .310-.517, respectively). Subgroup analyses indicated no interaction among each stratification variable and glucocorticoid use. Conclusion: Glucocorticoid use was associated with an increased mortality risk in critically ill patients with heart failure.
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Affiliation(s)
- Jia-Liang Zhu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China,Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liang Hong
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shi-Qi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiao-Mei Xu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China,Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jian-Rui Wei
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China,*Correspondence: Jian-Rui Wei, ; Hai-Yan Yin,
| | - Hai-Yan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China,*Correspondence: Jian-Rui Wei, ; Hai-Yan Yin,
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Li S, Zhao Q, Zhen Y, Li L, Mi Y, Li T, Liu K, Liu C. The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study. Int J Gen Med 2021; 14:6693-6701. [PMID: 34675630 PMCID: PMC8520478 DOI: 10.2147/ijgm.s334132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/22/2021] [Indexed: 01/06/2023] Open
Abstract
Background Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP). Methods The medical records of 144 consecutive patients with HF-LBP who received glucocorticoids as an adjunctive treatment to facilitate the up-titration of β-blocker and angiotensin-converting enzyme inhibitor were reviewed. Results After four weeks of treatment, the metoprolol and captopril (or equivalent) dosages were progressively and consistently increased from 25 (interquartile range [IQR] = 12.5-75 mg/day) to 100 mg/day (IQR = 50-178.8 mg/day) and from 0 (IQR = 0-25 mg/day) to 12.5 mg/day (IQR = 0-50 mg/day), respectively. There was a remarkable beneficial hemodynamic response to the glucocorticoid treatment signified by an increase in blood pressure and decrease in heart rate. The average heart rate decreased by 6 beat per minute (bpm) (0.5-16 bpm), and the mean arterial blood pressure increased from 74.06 ± 7.81 to 78.85 ± 7.91 mmHg. We also observed an improvement in renal function and an increased diuretic response following glucocorticoid treatment. As a result, the left ventricular ejection fraction increased from 28.92 ± 8.06% to 33.86 ± 8.76%, and the diuretic response increased from 776.7 mL/40 mg furosemide (IQR = 133.8-2000 mL) to 4000 mL/40 mg furosemide on day 28 (IQR = 2200-5925 mL). Conclusion The use of glucocorticoid treatment to maintain hemodynamic and renal functional targets when titrating guideline-directed medical treatment in patients with HF-LBP may be safe, effective, and feasible.
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Affiliation(s)
- Shuyu Li
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China.,The Second Cardiology Division, North China University of Science and Technology Affiliated Hospital, Tangshan, 063000, People's Republic of China
| | - Qingzhen Zhao
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
| | - Yuzhi Zhen
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
| | - Lizhuo Li
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
| | - Yiqing Mi
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
| | - Tongxin Li
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
| | - Kunshen Liu
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
| | - Chao Liu
- The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People's Republic of China
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Cho SA, Huh I, Lee SJ, Sung TY, Ku GW, Cho CK, Jee YS. Effects of dexamethasone on catheter-related bladder discomfort and emergence agitation: A prospective, randomized, and controlled trial. Korean J Anesthesiol 2021; 75:71-78. [PMID: 34551471 PMCID: PMC8831440 DOI: 10.4097/kja.21284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Catheter-related bladder discomfort (CRBD) is common in patients with a urinary catheter and is a risk factor for emergence agitation (EA). The mainstay of CRBD management is anticholinergics. Dexamethasone inhibits acetylcholine release. This study aimed to evaluate the effects of dexamethasone on postoperative CRBD and EA. Methods In this prospective study, 90 patients undergoing urological surgery requiring urinary catheterization were allocated randomly to one of two groups (each n = 45). Before induction of anesthesia, the dexamethasone group received 10 mg (2 ml) of dexamethasone intravenously, while the control group received 2 ml of saline in the same manner. The incidence and severity of CRBD were assessed 0, 1, 2, and 6 h after the patient arrived in the post-anesthesia care unit (PACU) as the primary outcomes. The incidence and severity of EA were also compared during emergence and recovery from anesthesia as secondary outcomes. Results The incidences of CRBD in the control group and dexamethasone group at 0, 1, 2, and 6 h postoperatively were 28.9% and 15.6%, 55.6% and 55.6%, 57.8% and 46.7%, and 53.3% and 51.1%, respectively. The incidence and severity of CRBD assessed at 0, 1, 2, and 6 h postoperatively did not show intergroup differences. The incidence and severity of EA in the operating room and PACU also showed no difference between the groups. Conclusions Dexamethasone (10 mg) administered before induction of anesthesia did not further reduce the incidence or severity of CRBD or EA in patients undergoing urological surgery.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Inho Huh
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Gwan Woo Ku
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Young Seok Jee
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Zhu XR, Ge N, Wang Y, Zhai JL, Liu C. Corticosteroids significantly increase cystatin C levels in the plasma by promoting cystatin C production in rats. Ren Fail 2020; 41:698-703. [PMID: 31352865 PMCID: PMC6711078 DOI: 10.1080/0886022x.2019.1638798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Several studies have shown that non-renal factors such as corticosteroids may increase plasma cystatin C levels without affecting kidney function. However, the mechanisms underlying this are unclear. We hypothesized that corticosteroids may increase cystatin C levels in the plasma by promoting its production in tissues. In the present study, we aimed to test our hypothesis in rats by investigating the effect of corticosteroids on cystatin C production in tissues and the glomerular filtration rate (GFR), as measured by the gold standard method (i.e., inulin clearance). Results: Dexamethasone treatment was associated with much higher concentrations of cystatin C in all organ tissue homogenates tested. Dexamethasone increased plasma cystatin C levels in rats, without any decrease in renal inulin clearance. The impact of dexamethasone on plasma and organ tissue cystatin C levels was abolished by RU486, indicating the effect was glucocorticoid receptor-mediated. Conclusions: Our study provides direct evidence that corticosteroids may increase cystatin C levels in the plasma by promoting its production, without any decrease in GFR.
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Affiliation(s)
- Xiao-Ran Zhu
- a Department of Pharmacy, Hebei General Hospital , Shijiazhuang , China.,b The First Cardiology Division, The First Hospital of Hebei Medical University , Shijiazhuang , China
| | - Ning Ge
- c School of Medicine, Regenerative Medicine Institute, National University of Ireland Galway , Galway , Ireland
| | - Yu Wang
- b The First Cardiology Division, The First Hospital of Hebei Medical University , Shijiazhuang , China
| | - Jian-Long Zhai
- d Cardiology Division, Hebei General Hospital , Shijiazhuang , China
| | - Chao Liu
- b The First Cardiology Division, The First Hospital of Hebei Medical University , Shijiazhuang , China.,e Cardiovascular Research Center, Hebei Medical University , Shijiazhuang , China
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