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Moor J, Kuhne M, Moschovitis G, Kobza R, Netzer S, Auricchio A, Beer JH, Bonati L, Reichlin T, Conen D, Osswald S, Rodondi N, Clair C, Baumgartner C, Aubert CE. Sex-specific association of cardiovascular drug doses with adverse outcomes in atrial fibrillation. Open Heart 2024; 11:e002720. [PMID: 39134361 PMCID: PMC11331917 DOI: 10.1136/openhrt-2024-002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Sex differences occur in atrial fibrillation (AF), including age at first manifestation, pathophysiology, treatment allocation, complication rates and quality of life. However, optimal doses of cardiovascular pharmacotherapy used in women with AF with or without heart failure (HF) are unclear. We investigated sex-specific associations of beta-blocker and renin-angiotensin system (RAS) inhibitor doses with cardiovascular outcomes in patients with AF or AF with concomitant HF. METHODS We used data from the prospective Basel Atrial Fibrillation and Swiss Atrial Fibrillation cohorts on patients with AF. The outcome was major adverse cardiovascular events (MACEs), including death, myocardial infarction, stroke, systemic embolisation and HF-related hospitalisation. Predictors of interest were spline (primary analysis) or quartiles (secondary analysis) of beta-blocker or RAS inhibitor dose in per cent of the maximum dose (reference), in interaction with sex. Cox models were adjusted for demographics, comorbidities and comedication. RESULTS Among 3961 patients (28% women), MACEs occurred in 1113 (28%) patients over a 5-year median follow-up. Distributions of RAS inhibitor and beta-blocker doses were similar in women and men. Cox models revealed no association between beta-blocker dose or RAS inhibitor dose and MACE. In a subgroup of patients with AF and HF, the lowest hazard of MACE was observed in women prescribed 100% of the RAS inhibitor dose. However, there was no association between RAS dose quartiles and MACE. CONCLUSIONS In this study of patients with AF, doses of beta-blockers and RAS inhibitors did not differ by sex and were not associated with MACE overall.
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Affiliation(s)
- Jeanne Moor
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Michael Kuhne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Cardiology Regional Hospital of Lugano, Cardiocentro Ticino, Lugano, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Seraina Netzer
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Angelo Auricchio
- Cardiology Regional Hospital of Lugano, Cardiocentro Ticino, Lugano, Switzerland
| | - Juerg H Beer
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Leo Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Carole Clair
- Department of Ambulatory Care, University of Lausanne, Lausanne, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
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Stamellou E, Sterzer V, Alam J, Roumeliotis S, Liakopoulos V, Dounousi E. Sex-Specific Differences in Kidney Function and Blood Pressure Regulation. Int J Mol Sci 2024; 25:8637. [PMID: 39201324 PMCID: PMC11354550 DOI: 10.3390/ijms25168637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
Premenopausal women generally exhibit lower blood pressure and a lower prevalence of hypertension than men of the same age, but these differences reverse postmenopause due to estrogen withdrawal. Sexual dimorphism has been described in different components of kidney physiology and pathophysiology, including the renin-angiotensin-aldosterone system, endothelin system, and tubular transporters. This review explores the sex-specific differences in kidney function and blood pressure regulation. Understanding these differences provides insights into potential therapeutic targets for managing hypertension and kidney diseases, considering the patient's sex and hormonal status.
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Affiliation(s)
- Eleni Stamellou
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, 52074 Aachen, Germany (J.A.)
- Department of Nephrology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Viktor Sterzer
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, 52074 Aachen, Germany (J.A.)
| | - Jessica Alam
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, 52074 Aachen, Germany (J.A.)
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.R.); (V.L.)
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.R.); (V.L.)
| | - Evangelia Dounousi
- Department of Nephrology, University Hospital of Ioannina, 45500 Ioannina, Greece;
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de Paula Silva-Lalucci MP, Marques DCDS, Valdés-Badilla P, Andreato LV, Magnani Branco BH. Obesity as a Risk Factor for Complications and Mortality in Individuals with SARS-CoV-2: A Systematic Review. Nutrients 2024; 16:543. [PMID: 38398867 PMCID: PMC10892776 DOI: 10.3390/nu16040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
This systematic review aimed to analyze the available studies that identified overweight and/or obesity as a risk factor for mortality, use of respiratory support, and changes in biochemical markers in adults hospitalized with SARS-CoV-2. The PubMed, Web of Science, and Scopus databases were searched using PRISMA guidelines until January 2024. The protocol was registered with PROSPERO (code: CRD42024501551). Of the 473 articles, only 8 met the inclusion criteria (e.g., adult individuals aged 18 or over diagnosed with COVID-19 individuals with overweight and/or obesity). In addition, the Downs and Black tool was used to assess the quality of the studies. The studies analyzed totaled 9782 adults hospitalized for COVID-19, indicating that overweight and obesity are present in more than half of adults. Diseases such as diabetes mellitus and hypertension are more prevalent in adults with obesity. The systematic review also highlighted that a higher incidence of respiratory support is related to a higher incidence of hospitalization in intensive care units and that adults with overweight and obesity have a higher risk of mortality from COVID-19. Biochemical markers such as procalcitinin, C-reactive protein, and interleukin-6 are associated with the severity of COVID-19 infection. This systematic review exposed overweight and/or obesity as a risk factor for worse COVID-19 disease, as well as for the need for intensive care, respiratory support, mortality, and changes in essential blood markers.
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Affiliation(s)
- Marielle Priscila de Paula Silva-Lalucci
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
| | - Déborah Cristina de Souza Marques
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca 3530000, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar 2520000, Chile
| | - Leonardo Vidal Andreato
- Higher School of Health Sciences, State University of Amazonas, Manaus 69065-001, Amazonas, Brazil;
| | - Braulio Henrique Magnani Branco
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
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Aydin D, Allach Y, Brugts JJ. Implications of Sex Differences on the Treatment Effectiveness in Heart Failure with Reduced Ejection Fraction Related to Clinical Endpoints and Quality of Life. Curr Heart Fail Rep 2024; 21:43-52. [PMID: 38060192 PMCID: PMC10827832 DOI: 10.1007/s11897-023-00638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF THE REVIEW This narrative review will emphasize the necessity for more female enrollment in heart failure (HF) trials and proposes future investigations regarding optimal dosages. Ultimately, a deeper understanding of the unique pathophysiology and medication responses in both men and women is crucial for effective HF management and may improve the quality of life in women. RECENT FINDINGS An analysis of 740 cardiovascular studies reveals that women make up only 38.2% of participants on average. Regarding to trials testing the effectiveness of HF medications, women's involvement are as low as 23.1%. While current guidelines lack sex-specific treatment recommendations, emerging research suggests differential medication dosages could be beneficial. Studies indicate that women may achieve comparable outcomes with lower doses of certain medications (angiotensin-receptor blockers) compared to men, signaling potential for more tailored dosing approaches. We advocate that the next step in HF research should prioritize the importance of tailoring treatment for HF patients by taking into account the variations in drug absorption and distribution among women.
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Affiliation(s)
- D Aydin
- Department of Cardiology, Erasmus University Medical Centre, 3015, Rotterdam, The Netherlands.
| | - Y Allach
- Department of Cardiology, Erasmus University Medical Centre, 3015, Rotterdam, The Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus University Medical Centre, 3015, Rotterdam, The Netherlands
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Nguyen VA, Zhang L, Kagan L, Rowland M, Mager DE. Target Reserve and Turnover Parameters Determine Rightward Shift of Enalaprilat Potency From its Binding Affinity to the Angiotensin Converting Enzyme. J Pharm Sci 2024; 113:167-175. [PMID: 37871777 DOI: 10.1016/j.xphs.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
Drug effects are often assumed to be directly proportional to the fraction of occupied targets. However, for a number of antagonists that exhibit target-mediated drug disposition (TMDD), such as angiotensin-converting enzyme (ACE) inhibitors, drug binding to the target at low concentrations may be significant enough to influence pharmacokinetics but insufficient to elicit a drug response (i.e., differences in drug-target binding affinity and potency). In this study, a pharmacokinetic/pharmacodynamic model for enalaprilat was developed in humans to provide a theoretical framework for assessing the relationship between ex vivo drug potency (IC50) and in vivo target-binding affinity (KD). The model includes competitive binding of angiotensin I and enalaprilat to ACE and accounts for the circulating target pool. Data were obtained from the literature, and model fitting and parameter estimation were conducted using maximum likelihood in ADAPT5. The model adequately characterized time-courses of enalaprilat concentrations and four biomarkers in the renin-angiotensin system and provided estimates for in vivo KD (0.646 nM) and system-specific parameters, such as total target density (32.0 nM) and fraction of circulating target (19.8%), which were in agreement with previous reports. Model simulations were used to predict the concentration-effect curve of enalaprilat, revealing a 6.3-fold increase in IC50 from KD. Additional simulations demonstrated that target reserve and degradation parameters are key factors determining the extent of shift of enalaprilat ex vivo potency from its in vivo binding affinity. This may be a common phenomenon for drugs exhibiting TMDD and has implications for translating binding affinity to potency in drug development.
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Affiliation(s)
- Van Anh Nguyen
- Department of Pharmaceutical Sciences, University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Li Zhang
- Department of Pharmaceutical Sciences, University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Leonid Kagan
- Department of Pharmaceutical Sciences, University at Buffalo, the State University of New York, Buffalo, NY, USA; Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Malcolm Rowland
- Centre for Applied Pharmacokinetic Research, University of Manchester, Manchester, UK
| | - Donald E Mager
- Department of Pharmaceutical Sciences, University at Buffalo, the State University of New York, Buffalo, NY, USA; Enhanced Pharmacodynamics, LLC, Buffalo, NY, USA.
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Choi SA, Jee HJ, Bormate KJ, Kim Y, Jung YS. Sex Differences in the Preventive Effect of Cardiovascular and Metabolic Therapeutics on Dementia. Biomol Ther (Seoul) 2023; 31:583-598. [PMID: 37899743 PMCID: PMC10616511 DOI: 10.4062/biomolther.2023.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 10/31/2023] Open
Abstract
Dementia is a clinical syndrome characterized by progressive impairment of cognitive and functional abilities. As currently applied treatments for dementia can only delay the progression of dementia and cannot fundamentally cure it, much attention is being paid to reducing its incidence by preventing the associated risk factors. Cardiovascular and metabolic diseases are well-known risk factors for dementia, and many studies have attempted to prevent dementia by treating these risk factors. Growing evidence suggests that sex-based factors may play an important role in the pathogenesis of dementia. Therefore, a deeper understanding of the differences in the effects of drugs based on sex may help improve their effectiveness. In this study, we reviewed sex differences in the impact of therapeutics targeting risk factors for dementia, such as cardiovascular and metabolic diseases, to prevent the incidence and/or progression of dementia.
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Affiliation(s)
- Sun Ah Choi
- Graduate School of Global Pharmaceutical Industry and Clinical Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Hye Jin Jee
- AI-Super convergence KIURI Translational Research Center, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | | | - Yeonjae Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Yi-Sook Jung
- Graduate School of Global Pharmaceutical Industry and Clinical Pharmacy, Ajou University, Suwon 16499, Republic of Korea
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
- Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea
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7
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Wang H, Shi L, Lin Y, Wang Y, Niu W, Li Y. Efficacy of fosinopril and amlodipine in pediatric primary hypertension: a single-center observational study. Front Pediatr 2023; 11:1247192. [PMID: 37964810 PMCID: PMC10641687 DOI: 10.3389/fped.2023.1247192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Objective Fosinopril and amlodipine are commonly prescribed as first-line pharmacotherapeutic agents for pediatric hypertension, but there is a lack of comparative studies regarding the efficacy of these two drugs. We aimed to evaluate and compare the efficacy of fosinopril and amlodipine monotherapy in pediatric primary hypertension. Methods This was a single-center, bidirectional observational study. A total of 175 children and adolescents with primary hypertension receiving antihypertensive monotherapy from July 2020 to February 2023 were enrolled. According to antihypertensive drugs, they were divided into the fosinopril group (n = 96) and the amlodipine group (n = 79). Subgroup analysis was performed to compare the efficacy of the two groups in terms of blood pressure (BP) control rates and reductions following a 4-week treatment. Results After 4 weeks of treatment, both groups achieved significant reductions in systolic BP (SBP) and diastolic BP (DBP) by more than 18 mmHg and 6 mmHg, respectively, with BP control rates of 61.5% in the fosinopril group and 59.5% in the amlodipine group, revealing no significant differences in the antihypertensive efficacy between the two groups except for DBP control rate (FDR adjusted P > 0.05). Further subsequent subgroup analyses revealed that the reductions in SBP and DBP in the fosinopril group were significantly greater than those in the amlodipine group in patients of females and hypo-HDL-cholesterolemia (FDR adjusted P < 0.05), and there was a trend of difference, although not significant, in patients with central obesity and insulin resistance (IR) (FDR adjusted 0.05 < P ≤ 0.1). However, there were no significant differences in treatment efficacy in patients without these characteristics. Furthermore, hypertriglyceridemia did not exhibit a significant association with the difference in treatment efficacy between the two medications (FDR adjusted P > 0.05). Conclusions Fosinopril and amlodipine monotherapy were both effective in pediatric primary hypertension during a short-term follow-up. Fosinopril may be particularly effective in reducing BP in hypertensive patients of females, central obesity, IR, and hypo-HDL-cholesterolemia. These findings indicate that optimizing antihypertensive medication selection based on the individualized characteristics of children with hypertension may improve the efficacy of antihypertensive treatment.
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Affiliation(s)
- Hui Wang
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lin Shi
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cardiology, Children’s Hospital Capital Institute of Pediatrics, Beijing, China
| | - Yao Lin
- Department of Cardiology, Children’s Hospital Capital Institute of Pediatrics, Beijing, China
| | - Yuting Wang
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Yaqi Li
- Department of Cardiology, Children’s Hospital Capital Institute of Pediatrics, Beijing, China
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8
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de Ruiter SC, Schmidt AF, Grobbee DE, den Ruijter HM, Peters SAE. Sex-specific Mendelian randomisation to assess the causality of sex differences in the effects of risk factors and treatment: spotlight on hypertension. J Hum Hypertens 2023; 37:602-608. [PMID: 37024639 PMCID: PMC10403357 DOI: 10.1038/s41371-023-00821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
Hypertension is a key modifiable risk factor for cardiovascular disease. Several observational studies have found a stronger association of blood pressure and cardiovascular disease risk in women compared to men. Since observational studies can be affected by sex-specific residual confounding and reverse causation, it remains unclear whether these differences reflect actual differential effects. Other study designs are needed to uncover the causality of sex differences in the strength of risk factor and treatment effects. Mendelian randomisation (MR) uses genetic variants as instrumental variables to provide evidence about putative causal relations between risk factors and outcomes. By exploiting the random allocation of genes at gamete forming, MR is unaffected by confounding and results in more reliable causal effect estimates. In this review, we discuss why and how sex-specific MR and cis-MR could be used to study sex differences in risk factor and drug target effects. Sex-specific MR can be helpful to strengthen causal inferences in the field of sex differences, where it is often challenging to distinguish nature from nurture. The challenge of sex-specific (drug target) MR lays in leveraging robust genetic instruments from sex-specific GWAS studies which are not commonly available. Knowledge on sex-specific causal effects of hypertension, or other risk factors, could improve clinical practice and health policies by tailoring interventions based on personalised risk. Drug target MR can help to determine the anticipated on-target effects of a drug compound and to identify targets to pursue in drug development.
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Affiliation(s)
- Sophie C de Ruiter
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Floriaan Schmidt
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator Centre, London, UK
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
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Tamargo J, Caballero R, Mosquera ED. Sex and gender differences in the treatment of arterial hypertension. Expert Rev Clin Pharmacol 2023; 16:329-347. [PMID: 36891888 DOI: 10.1080/17512433.2023.2189585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Arterial hypertension represents the leading modifiable risk factor for all-cause death and early development of cardiovascular disease in women. Current clinical guidelines for the treatment of hypertension noted that women respond to antihypertensive drugs similarly to men and, therefore, treatment recommendations remain the same for both sexes. However, clinical evidence suggests the existence of sex- and gender-related differences (SGRD) in the prevalence, pathophysiology, pharmacodynamics (efficacy and safety) and pharmacokinetics of antihypertensive drugs. AREAS COVERED This review summarizes SGRD in the prevalence of hypertension, hypertension-mediated organ damage and blood pressure control, prescription patterns, and pharmacokinetics/ pharmacodynamics and doses of antihypertensive drugs. EXPERT OPINION There is limited information on SGRD in antihypertensive drug efficacy because of the underrepresentation of women in randomized clinical trials and, more important, because few trials reported results stratified by sex or performed sex-specific analyses. However, there are SGRD in hypertension-mediated organ damage, drug pharmacokinetics and, particularly, in drug safety. Prospective trials specifically designed to better understand the basis for SGRD in the pathophysiology of hypertension and in the efficacy and safety of antihypertensive drugs are needed to achieve a more personalized treatment of hypertension and hypertension-mediated organ damage in women.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Eva Delpón Mosquera
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
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Sexual Dimorphism in the Expression of Cardiac and Hippocampal Renin-Angiotensin and Kallikrein–Kinin Systems in Offspring from Mice Exposed to Alcohol during Gestation. Antioxidants (Basel) 2023; 12:antiox12030541. [PMID: 36978790 PMCID: PMC10045732 DOI: 10.3390/antiox12030541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Prenatal alcohol exposure (PAE) impairs fetal development. Alcohol consumption was shown to modulate the renin–angiotensin system (RAS). This study aimed to analyze the effects of PAE on the expression of the renin–angiotensin system (RAS) and kallikrein–kinin system (KKS) peptide systems in the hippocampus and heart of mice of both sexes. C57Bl/6 mice were exposed to alcohol during pregnancy at a concentration of 10% (v/v). On postnatal day 45 (PN45), mouse hippocampi and left ventricles (LV) were collected and processed for messenger RNA (mRNA) expression of components of the RAS and KKS. In PAE animals, more pronounced expression of AT1 and ACE mRNAs in males and a restored AT2 mRNA expression in females were observed in both tissues. In LV, increased AT2, ACE2, and B2 mRNA expressions were also observed in PAE females. Furthermore, high levels of H2O2 were observed in males from the PAE group in both tissues. Taken together, our results suggest that modulation of the expression of these peptidergic systems in PAE females may make them less susceptible to the effects of alcohol.
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Tsirka A. Gender Differences in Cardiovascular Health: Hormonal Effects on Cardiovascular Risk and Management. Handb Exp Pharmacol 2023; 282:201-218. [PMID: 37468722 DOI: 10.1007/164_2023_668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Cardiovascular disease is the number one cause of death worldwide both in men and women. Significant differences however exist in the age of onset, type of cardiovascular disease (CVD), and treatment response among the genders. These differences are due to both gender societal effects and biological differences from the influence of the hormonal and metabolic milieu in the two sexes.Estrogens are the main female hormone. They impact signaling in almost every body organ and thus affect cardiovascular risk factors. These result in differential expression of CVD. The differential effect of treatment modalities is only recently being evaluated.Research is ongoing regarding the pathophysiology of these differences. Our current level of knowledge is described in this chapter.
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Affiliation(s)
- Anna Tsirka
- University of Connecticut School of Medicine, Farmington, CT, USA.
- Connecticut Children's Medical Center, Hartford, CT, USA.
- St Christopher's Children's Hospital, Drexel University Medical School, Philadelphia, PA, USA.
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Goyal P, Chhabra ST, Jyotsna M. Hypertension in Women: The Current Understanding and Future Goals. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hypertension is one of the major contributing risk factor of cardiovascular diseases. Despite enormous advances in the preventive cardiology, hypertension remains the leading cause of death and disability in women. The article aims to focus on the gender specific differences in hypertension, and existing gaps in the current understanding of high blood pressure (BP) in women. Apart from epidemiological differences, hypertension in men and women has distinct pathophysiological mechanisms, impact on cardiovascular system, awareness and control. Prevalence of hypertension is higher in men than women till menopause; following this the prevalence rises steeply in women, and exceeds that of men above 75 years of age. Women with their estrogenic environment are relatively protected from high BP as their hormonal/chromosomal profile govern expression of alternate renin angiotensin axis (RAS) pathway and anti-inflammatory, vasodilatory, anti-proliferative immune cells whereas in males, classical RAS driven inflammatory, pro-hypertensive and proliferative milieu confers higher risk of hypertension. Thus, immunotherapy can have a potential therapeutic role in the treatment of hypertension in future. Cardiovascular consequences of high BP are worse in women than men in majority of trials. Women are now getting more aware of hypertension but the control of BP still remains poorer than men, especially in older age group. There are some noteworthy pharmacokinetic and pharmacogenomics gender differences in response to various antihypertensive drugs, which can be taken into consideration while choosing a particular class of drugs in female population. Standard treatment guidelines recommend same BP targets and management strategies in both the genders, but the trials so far have not been designed in a way to draw women specific conclusions on optimal cut-offs for diagnosis and treatment of BP due to under representation of women in majority of trials. More women centered analysis in future hypertension research projects can provide better scientific insights in various clinical aspects of hypertension.
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Affiliation(s)
- Prerna Goyal
- Department of Medicine, RG Stone and Super-speciality Hospital, Ludhiana, Punjab, India
| | - Shibba Takkar Chhabra
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - M. Jyotsna
- Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India,
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Singh R, Nasci VL, Guthrie G, Ertuglu LA, Butt MK, Kirabo A, Gohar EY. Emerging Roles for G Protein-Coupled Estrogen Receptor 1 in Cardio-Renal Health: Implications for Aging. Biomolecules 2022; 12:412. [PMID: 35327604 PMCID: PMC8946600 DOI: 10.3390/biom12030412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular (CV) and renal diseases are increasingly prevalent in the United States and globally. CV-related mortality is the leading cause of death in the United States, while renal-related mortality is the 8th. Despite advanced therapeutics, both diseases persist, warranting continued exploration of disease mechanisms to develop novel therapeutics and advance clinical outcomes for cardio-renal health. CV and renal diseases increase with age, and there are sex differences evident in both the prevalence and progression of CV and renal disease. These age and sex differences seen in cardio-renal health implicate sex hormones as potentially important regulators to be studied. One such regulator is G protein-coupled estrogen receptor 1 (GPER1). GPER1 has been implicated in estrogen signaling and is expressed in a variety of tissues including the heart, vasculature, and kidney. GPER1 has been shown to be protective against CV and renal diseases in different experimental animal models. GPER1 actions involve multiple signaling pathways: interaction with aldosterone and endothelin-1 signaling, stimulation of the release of nitric oxide, and reduction in oxidative stress, inflammation, and immune infiltration. This review will discuss the current literature regarding GPER1 and cardio-renal health, particularly in the context of aging. Improving our understanding of GPER1-evoked mechanisms may reveal novel therapeutics aimed at improving cardio-renal health and clinical outcomes in the elderly.
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Affiliation(s)
- Ravneet Singh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Medical Research Building IV, Nashville, TN 37232, USA; (R.S.); (V.L.N.)
| | - Victoria L. Nasci
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Medical Research Building IV, Nashville, TN 37232, USA; (R.S.); (V.L.N.)
| | - Ginger Guthrie
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (G.G.); (M.K.B.)
| | - Lale A. Ertuglu
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (L.A.E.); (A.K.)
| | - Maryam K. Butt
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (G.G.); (M.K.B.)
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (L.A.E.); (A.K.)
| | - Eman Y. Gohar
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Medical Research Building IV, Nashville, TN 37232, USA; (R.S.); (V.L.N.)
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Implications of testicular ACE2 and the renin-angiotensin system for SARS-CoV-2 on testis function. Nat Rev Urol 2022; 19:116-127. [PMID: 34837081 PMCID: PMC8622117 DOI: 10.1038/s41585-021-00542-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 12/16/2022]
Abstract
Although many studies have focused on SARS-CoV-2 infection in the lungs, comparatively little is known about the potential effects of the virus on male fertility. SARS-CoV-2 infection of target cells requires the presence of furin, angiotensin-converting enzyme 2 (ACE2) receptors, and transmembrane protease serine 2 (TMPRSS2). Thus, cells in the body that express these proteins might be highly susceptible to viral entry and downstream effects. Currently, reports regarding the expression of the viral entry proteins in the testes are conflicting; however, other members of the SARS-CoV family of viruses - such as SARS-CoV - have been suspected to cause testicular dysfunction and/or orchitis. SARS-CoV-2, which displays many similarities to SARS-CoV, could potentially cause similar adverse effects. Commonalities between SARS family members, taken in combination with sparse reports of testicular discomfort and altered hormone levels in patients with SARS-CoV-2, might indicate possible testicular dysfunction. Thus, SARS-CoV-2 infection has the potential for effects on testis somatic and germline cells and experimental approaches might be required to help identify potential short-term and long-term effects of SARS-CoV-2 on male fertility.
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Hu R, McDonough AA, Layton AT. Sex differences in solute and water handling in the human kidney: Modeling and functional implications. iScience 2021; 24:102667. [PMID: 34169242 PMCID: PMC8209279 DOI: 10.1016/j.isci.2021.102667] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
The kidneys maintain homeostasis by controlling the amount of water and electrolytes in the blood. That function is accomplished by the nephrons, which transform glomerular filtrate into urine by a transport process mediated by membrane transporters. We postulate that the distribution of renal transporters along the nephron is markedly different between men and women, as recently shown in rodents. We hypothesize that the larger abundance of a renal Na+ transport in the proximal tubules in females may also better prepare them for the fluid retention adaptations required during pregnancy and lactation. Also, kidneys play a key role in blood pressure regulation, and a popular class of anti-hypertensive medications and angiotensin converting enzymes (ACE) inhibitors have been reported to be less effective in women. Model simulations suggest that the blunted natriuretic and diuretic effects of ACE inhibition in women can be attributed, in part, to their higher distal baseline transport capacity.
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Affiliation(s)
- Rui Hu
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alicia A. McDonough
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anita T. Layton
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Department of Biology, Cheriton School of Computer Science, and School of Pharmacology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Flores-Monroy J, Lezama-Martínez D, Fonseca-Coronado S, Martínez-Aguilar L. Differences in the expression of the renin angiotensin system and the kallikrein-kinin system during the course of myocardial infarction in male and female Wistar rats. J Renin Angiotensin Aldosterone Syst 2021; 21:1470320319900038. [PMID: 32458737 PMCID: PMC7268575 DOI: 10.1177/1470320319900038] [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] [Indexed: 12/14/2022] Open
Abstract
Background: There is some evidence that components of the renin-angiotensin system and
kallikrein-kinin system are not similarly regulated in both sexes. The aim
of this work was to analyze the expression of angiotensin-converting enzyme,
angiotensin-converting enzyme 2, angiotensin 1 receptor, angiotensin 2
receptor, beta-1 receptor, and beta-2 receptor during the evolution of
myocardial infarction. Methods: Thirty-six male and 36 female Wistar rats were used. Myocardial infarction
was induced. Six groups of both sexes were formed, (n=6):
(a) sham; (b) 48 h myocardial infarction; (c) one week myocardial
infarction; (d) two weeks myocardial infarction; (e) three weeks myocardial
infarction and (f) four weeks myocardial infarction. The expression was
evaluated by real-time polymerase chain reaction on the penumbra of left
ventricle. Results: The mRNA expression of most biomarkers was lower in females than in males.
During acute infarction, an increase of all protein expression was found in
female and at two weeks while in the male only biomarker changes occurred at
three weeks. In addition, in male biomarkers mRNA expression decreased
during chronic infarction while in females it did not. Conclusions: The renin-angiotensin system and kallikrein-kinin system biomarkers
expression occurs at earlier times in the female than in the male rat. In
addition, during chronic myocardial infarction these biomarkers remained
unchanged in females while in males they decreased.
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Affiliation(s)
- Jazmín Flores-Monroy
- Laboratorio de Farmacologia del Miocardio, Universidad Nacional Autonoma de Mexico, Mexico
| | - Diego Lezama-Martínez
- Laboratorio de Farmacologia del Miocardio, Universidad Nacional Autonoma de Mexico, Mexico
| | - Salvador Fonseca-Coronado
- Laboratorio de Inmunobiología de Enfermedades Infecciosas, Universidad Nacional Autonoma de Mexico, Mexico
| | - Luisa Martínez-Aguilar
- Laboratorio de Farmacologia del Miocardio, Universidad Nacional Autonoma de Mexico, Mexico
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Gao X, Yamazaki Y, Tezuka Y, Omata K, Ono Y, Morimoto R, Nakamura Y, Satoh F, Sasano H. Gender differences in human adrenal cortex and its disorders. Mol Cell Endocrinol 2021; 526:111177. [PMID: 33582213 DOI: 10.1016/j.mce.2021.111177] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
The adrenal cortex plays pivotal roles in the maintenance of blood volume, responsiveness to stress and the development of gender characteristics. Gender differences of human adrenal cortex have been recently reported and attracted increasing interests. Gender differences occur from the developing stage of the adrenal, in which female subjects had more activated stem cells with higher renewal capacity resulting in gender-associated divergent structures and functions of cortical zonations of human adrenal. Female subjects generally have the lower blood pressure with the lower renin levels and ACE activities than male subjects. In addition, HPA axis was more activated in female than male, which could possibly contribute to gender differences in coping with various stressful events in our life. Of particular interest, estrogens were reported to suppress RAAS but activate HPA axis, whereas androgens had opposite effects. In addition, adrenocortical disorders in general occur more frequently in female with more pronounced adrenocortical hormonal abnormalities possibly due to their more activated WNT and PRK signaling pathways with more abundant activated adrenocortical stem cells present in female adrenal glands. Therefore, it has become pivotal to clarify the gender influence on both clinical and biological features of adrenocortical disorders. We herein reviewed recent advances in these fields.
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Affiliation(s)
- Xin Gao
- Department of Pathology, Tohoku University Graduate School of Medicine, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Japan
| | - Yuta Tezuka
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Japan; Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Japan
| | - Kei Omata
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Japan; Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Japan
| | - Yoshikiyo Ono
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Japan
| | - Ryo Morimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Fumitoshi Satoh
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Japan; Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Japan.
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18
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Nicolaou PA. Sex differences in heart failure medications targeting the renin-angiotensin-aldosterone system. Eur J Pharmacol 2021; 897:173961. [PMID: 33617824 DOI: 10.1016/j.ejphar.2021.173961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) is a major healthcare problem. Sex-related differences in clinical manifestations, outcomes, risk factors and symptoms in HF have been described in the literature. Sex-related differences have also been described in the regulation of the renin-angiotensin-aldosterone system (RAAS), which is at the core of the pathophysiology of HF. Considering that drugs targeting RAAS are cornerstones in the treatment of HF, it is important to determine whether sex-related differences exist in the use of angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs) and ARB/neprilysin inhibitors (ARNIs). In regards to the relative efficacy of RAAS drugs in men vs. women in HF, there are conflicting results, which may stem from the fact that a lot of clinical trials were not specifically designed to investigate sex differences, with many of them having an underrepresentation of women. With respect to optimal dosage of RAAS drugs, even though, current HF guidelines, recommend up-titration to the same target dose in both men and women, evidence suggests that lower doses could be used in women. Furthermore, several studies have reported underutilization of guideline-directed medical therapy in women, including ACEIs, ARBs and MRAs, which may be at least partially attributed to increased prevalence of HF with a preserved ejection fraction and increased propensity for adverse effects in women. Overall, these investigations have shed some light on sex-related differences but there is scope for conducting further studies to determine the optimal use of RAAS drugs in men and women with failing hearts.
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Affiliation(s)
- Persoulla A Nicolaou
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Cyprus; Honorary Senior Lecturer, St. George's, University of London, UK.
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19
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Soeroto AY, Soetedjo NN, Purwiga A, Santoso P, Kulsum ID, Suryadinata H, Ferdian F. Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:1897-1904. [PMID: 33007661 PMCID: PMC7521380 DOI: 10.1016/j.dsx.2020.09.029] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Corona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients. METHODS We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality. RESULTS Sixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m2). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67-1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25-2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension. CONCLUSION Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.
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Affiliation(s)
- Arto Yuwono Soeroto
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia.
| | - Nanny Natalia Soetedjo
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Division of Endocrine and Metabolism, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Aga Purwiga
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Prayudi Santoso
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Iceu Dimas Kulsum
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Hendarsyah Suryadinata
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Ferdy Ferdian
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
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20
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Kalibala J, Pechère-Bertschi A, Desmeules J. Gender Differences in Cardiovascular Pharmacotherapy-the Example of Hypertension: A Mini Review. Front Pharmacol 2020; 11:564. [PMID: 32435193 PMCID: PMC7218117 DOI: 10.3389/fphar.2020.00564] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide in both sexes. Despite considerable progress in better understanding the patterns of disease in women, they are still often undertreated and benefit less from evidence-based treatment. Hypertension is a key contributor to CVD and is also one of the most potent risk factors for heart failure in women. Even with the wide variety of available drugs, blood pressure control is globally suboptimal. Current guidelines do not suggest differential treatment of hypertension for women; however, a growing body of research suggests gender dimorphism in the pathophysiology of hypertension and pharmacological response to cardiovascular drugs. The clinical relevance of theses sex-divergent effects of drugs is still under investigation. Owing to the exponential relationship between blood pressure and cardiovascular mortality, even a modest decrease in blood pressure or therapeutic adhesion could be clinically \relevant. In this review, we explore the known pharmacological and pharmacokinetic sex differences with special attention to the main classes of antihypertensive treatment. Current data shows frequently higher drug exposures in women and more frequent adverse drug reactions in all antihypertensive drug groups. As far as cardiovascular prevention is concerned, sex-specific data is often lacking in clinical trials, highlighting the necessity to further study CVD and their treatment in both men and women.
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Affiliation(s)
| | - Antoinette Pechère-Bertschi
- Division of Nephrology and Hypertension, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology Pharmacology Emergency Medicine and Intensive Care, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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21
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Murrell DF, Murase JE. The Potential Protective Effect of Estrogen: A Plausible Theory for why COVID-19 Mortality is Lower in Females. Int J Womens Dermatol 2020; 6:152-153. [PMID: 32355869 PMCID: PMC7192108 DOI: 10.1016/j.ijwd.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Dedee F Murrell
- Department of Dermatology, St. George Hospital, UNSW Faculty of Medicine, Sydney, Australia
| | - Jenny E Murase
- Department of Dermatology, UCSF, San Francisco, CA, United States
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22
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Liu S, Ando F, Fujita Y, Liu J, Maeda T, Shen X, Kikuchi K, Matsumoto A, Yokomori M, Tanabe-Fujimura C, Shimokata H, Michikawa M, Komano H, Zou K. A clinical dose of angiotensin-converting enzyme (ACE) inhibitor and heterozygous ACE deletion exacerbate Alzheimer's disease pathology in mice. J Biol Chem 2019; 294:9760-9770. [PMID: 31072831 DOI: 10.1074/jbc.ra118.006420] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/07/2019] [Indexed: 12/23/2022] Open
Abstract
Inhibition of angiotensin-converting enzyme (ACE) is a strategy used worldwide for managing hypertension. In addition to converting angiotensin I to angiotensin II, ACE also converts neurotoxic β-amyloid protein 42 (Aβ42) to Aβ40. Because of its neurotoxicity, Aβ42 is believed to play a causative role in the development of Alzheimer's disease (AD), whereas Aβ40 has neuroprotective effects against Aβ42 aggregation and also against metal-induced oxidative damage. Whether ACE inhibition enhances Aβ42 aggregation or impairs human cognitive ability are very important issues for preventing AD onset and for optimal hypertension management. In an 8-year longitudinal study, we found here that the mean intelligence quotient of male, but not female, hypertensive patients taking ACE inhibitors declined more rapidly than that of others taking no ACE inhibitors. Moreover, the sera of all AD patients exhibited a decrease in Aβ42-to-Aβ40-converting activity compared with sera from age-matched healthy individuals. Using human amyloid precursor protein transgenic mice, we found that a clinical dose of an ACE inhibitor was sufficient to increase brain amyloid deposition. We also generated human amyloid precursor protein/ACE+/- mice and found that a decrease in ACE levels promoted Aβ42 deposition and increased the number of apoptotic neurons. These results suggest that inhibition of ACE activity is a risk factor for impaired human cognition and for triggering AD onset.
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Affiliation(s)
- Shuyu Liu
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan.,the Liaoning Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Shenyang Medical College, Shenyang 110034, China
| | - Fujiko Ando
- the Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute 480-1146, Japan
| | - Yu Fujita
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Junjun Liu
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Tomoji Maeda
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Xuefeng Shen
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Kota Kikuchi
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Aoi Matsumoto
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Mirai Yokomori
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Chiaki Tanabe-Fujimura
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan
| | - Hiroshi Shimokata
- the Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin 470-0196, Japan, and
| | - Makoto Michikawa
- the Department of Biochemistry, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Hiroto Komano
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan,
| | - Kun Zou
- From the Department of Neuroscience, School of Pharmacy, Iwate Medical University, Yahaba 028-3694, Japan, .,the Department of Biochemistry, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
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23
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Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci (Lond) 2017; 130:1147-63. [PMID: 27252402 DOI: 10.1042/cs20160047] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/29/2016] [Indexed: 01/04/2023]
Abstract
Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications.
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Fernández-Atucha A, Izagirre A, Fraile-Bermúdez AB, Kortajarena M, Larrinaga G, Martinez-Lage P, Echevarría E, Gil J. Sex differences in the aging pattern of renin-angiotensin system serum peptidases. Biol Sex Differ 2017; 8:5. [PMID: 28174624 PMCID: PMC5291971 DOI: 10.1186/s13293-017-0128-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/31/2017] [Indexed: 01/01/2023] Open
Abstract
Background Serum peptidases, such as angiotensin-converting enzyme (ACE), angiotensin-converting enzyme-2 (ACE2), neutral endopeptidase (NEP), aminopeptidase N (APN), and aminopeptidase A (APA), are important elements of the renin–angiotensin system (RAS). Dysregulation of these enzymes has been associated with hypertension and cardiovascular risk. In the present study, serum activities of RAS peptidases were analyzed to evaluate the existence of sexual differences, with a possible different pattern in pre- and post-andropausal/post-menopausal participants. Methods One hundred and eighteen healthy men and women between 41 and 70 years of age (58 women and 60 men) were recruited to participate in the study. Serum RAS-regulating enzymes were measured by spectrofluorimetry. Enzymatic activity was recorded as units of enzyme per milliliter of serum (U/mL). Results Significantly lower serum APA activity was observed in men with respect to women; no sex differences were detected for ACE, ACE2, NEP, or APN. Significantly lower APA and ACE serum activity were observed in older men compared to older women. In contrast, younger (<55 years) men had significantly higher values of NEP serum activity than younger women. Significantly lower ACE serum activity was detected in older men compared to younger men. In women, significantly higher ACE2 serum activity was observed in older women compared to younger women. Conclusions These results suggest a differential effect of aging on the activity of RAS enzymes in men and women, especially with respect to the breakpoint of andropausia/menopausia, on the critical serum enzymatic activities of the RAS, which could correlate with sexual differences in cardiovascular risk.
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Affiliation(s)
- A Fernández-Atucha
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), P.O. Box 699, E-48080 Bilbao, Bizkaia Spain
| | - A Izagirre
- Department of Neurology, CITA-Alzheimer Foundation, San Sebastian, Spain
| | - A B Fraile-Bermúdez
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), P.O. Box 699, E-48080 Bilbao, Bizkaia Spain
| | - M Kortajarena
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), P.O. Box 699, E-48080 Bilbao, Bizkaia Spain
| | - G Larrinaga
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), P.O. Box 699, E-48080 Bilbao, Bizkaia Spain
| | - P Martinez-Lage
- Department of Neurology, CITA-Alzheimer Foundation, San Sebastian, Spain
| | - E Echevarría
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Physiology, Faculty of Medicine, University of the Basque Country (UPV/EHU), P.O. Box 699, E-48080 Bilbao, Bizkaia Spain
| | - J Gil
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Physiology, Faculty of Medicine, University of the Basque Country (UPV/EHU), P.O. Box 699, E-48080 Bilbao, Bizkaia Spain
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Mompeón A, Lázaro-Franco M, Bueno-Betí C, Pérez-Cremades D, Vidal-Gómez X, Monsalve E, Gironacci MM, Hermenegildo C, Novella S. Estradiol, acting through ERα, induces endothelial non-classic renin-angiotensin system increasing angiotensin 1-7 production. Mol Cell Endocrinol 2016; 422:1-8. [PMID: 26562171 DOI: 10.1016/j.mce.2015.11.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/29/2015] [Accepted: 11/02/2015] [Indexed: 12/31/2022]
Abstract
Intracellular renin-angiotensin system (RAS) can operate independently of the circulating RAS. Estrogens provide protective effects by modulating the RAS. Our aim was to investigate the effect of estradiol (E2) on angiotensin converting enzymes (ACE) 1 and ACE2 expression and activities in human endothelial cells (HUVEC), and the role of estrogen receptors (ER). The results confirmed the presence of active intracellular RAS in HUVEC. Physiological concentrations of E2 induced a concentration-dependent increase of ACE1 and ACE2 mRNA expression and ACE1, but not ACE2, protein levels. ACE1 and ACE2 enzymatic activities were also induced with E2. These effects were mediated through ERα activation, since ER antagonists ICI 182780 and MPP completely abolished the effect of E2. Moreover, the ERα agonist PPT mirrored the E2 effects on ACE1 and ACE2 protein expression and activity. Exposure of endothelial cells to E2 significantly increased Ang-(1-7) production. In conclusion, E2 increases Ang-(1-7) production, through ERα, involving increased ACE1 and ACE2 mRNA expression and activity and ACE1 protein levels.
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Affiliation(s)
- Ana Mompeón
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Macarena Lázaro-Franco
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Carlos Bueno-Betí
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Daniel Pérez-Cremades
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Xavier Vidal-Gómez
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Elena Monsalve
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Mariela M Gironacci
- Departament de Química Biológica, IQUIFIB-CONICET, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Carlos Hermenegildo
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
| | - Susana Novella
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
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Zamani Z, Nematbakhsh M, Eshraghi-Jazi F, Talebi A, Jilanchi S, Navidi M, Shirdavani S, Ashrafi F. Effect of enalapril in cisplatin-induced nephrotoxicity in rats; gender-related difference. Adv Biomed Res 2016; 5:14. [PMID: 26962516 PMCID: PMC4770600 DOI: 10.4103/2277-9175.175253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/17/2015] [Indexed: 11/05/2022] Open
Abstract
Background: The function of renin angiotensin system (RAS) is gender-related, and this system affects cisplatin (CP)-induced nephrotoxicity. In this study, we compared the effect of enalapril as an angiotensin-converting enzyme (ACE) inhibitor on CP-induced nephrotoxicity between male and female rats. Materials and Methods: Sixty-two adult male and female Wistar rats were divided into eight groups. Both genders received CP (2.5 mg/kg, i.p.) and enalapril (30 mg/kg, i.p.) for 7 days in compared with CP alone or enalapril alone or vehicle alone treated groups. At the end of the experiment, blood samples were obtained, and the kidney tissue was investigated for histopathological changes. Results: CP increased the serum levels of blood urea nitrogen and creatinine as well as kidney weight and kidney tissue damage score in both genders (P < 0.05). However, not only enalapril failed to ameliorate the aforementioned parameters in both genders, but also it intensified nephrotoxicity in females (P < 0.05). In addition, enalapril enhanced body weight loss induced by CP in females (P < 0.05). CP alone decreased kidney level of nitrite in both genders (P < 0.05) and enalapril could not reverse this decreasing. The combination of enalapril and CP significantly increased serum level of nitrite in females, but this was not observed in males (P < 0.05). Conclusion: Enalapril as an ACE inhibitor failed to ameliorate nephrotoxicity induced by CP in both male and female rats. In addition, enalapril aggravated CP-induced nephrotoxicity in female possibly due to gender-dependent RAS response.
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Affiliation(s)
- Zohreh Zamani
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nematbakhsh
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Institute of Basic and Applied Sciences Research, Isfahan, Iran
| | - Fatemeh Eshraghi-Jazi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ardeshir Talebi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Clinical Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Jilanchi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mitra Navidi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Shirdavani
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Ashrafi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Chen K, Bi J, Su Y, Chappell MC, Rose JC. Sex-Specific Changes in Renal Angiotensin-Converting Enzyme and Angiotensin-Converting Enzyme 2 Gene Expression and Enzyme Activity at Birth and Over the First Year of Life. Reprod Sci 2015; 23:200-10. [PMID: 26243544 DOI: 10.1177/1933719115597760] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) are key enzymes of the renin-angiotensin system. We investigated developmental changes in renal ACE and ACE2 gene expression and activity in both male and female sheep. METHODS Three groups of sheep (fetus, newborn, and adult) were used. Renal ACE and ACE2 activities, messenger RNA (mRNA), and protein expression were studied. RESULTS Renal ACE and ACE2 activities increased at 1 year in males, while there were no changes throughout development in females. Renal ACE and ACE2 mRNA and protein showed no sex differences but increased by 1 year of age. CONCLUSION There are sex-related differences in the development of renal-converting enzyme activities that may have functional implications in terms of the regulation of blood pressure and renal function in men and women. The difference in the patterns of gene expression and enzyme activity indicates that changes in gene expression may not accurately reflect changes in activity.
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Affiliation(s)
- Kai Chen
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianli Bi
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA Center of Research for Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yixin Su
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA Center of Research for Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark C Chappell
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James C Rose
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA Center of Research for Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Haroon J, Foureaux G, Martins AS, Ferreira AJ, Reis AM, Javed Q. Gender differences in normal left ventricle of adult FVB/N mice due to variation in interleukins and natriuretic peptides expression levels. Cytokine 2014; 71:54-9. [PMID: 25226444 DOI: 10.1016/j.cyto.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
This study examined the sex differences for physical, morphological, histological, mRNA, and protein expression levels changes for interleukins and natriuretic peptides in left ventricle (LV) of two groups of adult FVB/N mice; males (WM) and females (WF). LV morphological, histological, reverse transcription and quantitative real-time PCR (RT-PCR), and immunohistochemical (IHC) alterations were determined in FVB/N mice at 34-35 weeks on gender basis. Confirming the gender dimorphism, FVB/N males (WM) illustrated a significant reduction in ANP and IL1-A levels as well as significantly increased body weight (BW (gm)), tibia length (TL (mm)), heart weight (HW (mg)), heart weight-to-body weight (HW/BW (mg/gm)) ratio, heart weight-to-tibia length (HW/TL (mg/mm)) ratio, left ventricle weight (LV (mg)), left ventricle-to-body weight (LV/BW (mg/gm)) ratio, and left ventricle-to-tibia length (LV/TL (mg/mm)) ratio, left ventricular (LV) cardiomyocyte diameter, high BNP, NPRA, IL-1B, and IL1R1 expression in comparison with FVB/N females (WF). Gender differences in relation to left ventricle (LV) may be due to differences in the interleukins and natriuretic peptides levels as an outcome of sex related hormones.
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Affiliation(s)
- Javeria Haroon
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Department of Molecular Biology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Department of Morphology, Federal University of Minas Gerais (UFMG), 31270-010 Belo Horizonte, Minas Gerais, Brazil; Department of Physiology and Biophysics, Federal University of Minas Gerais (UFMG), 31270-010 Belo Horizonte, Minas Gerais, Brazil
| | - Giselle Foureaux
- Department of Morphology, Federal University of Minas Gerais (UFMG), 31270-010 Belo Horizonte, Minas Gerais, Brazil
| | - Almir S Martins
- Department of Physiology and Biophysics, Federal University of Minas Gerais (UFMG), 31270-010 Belo Horizonte, Minas Gerais, Brazil
| | - Anderson J Ferreira
- Department of Morphology, Federal University of Minas Gerais (UFMG), 31270-010 Belo Horizonte, Minas Gerais, Brazil
| | - Adelina M Reis
- Department of Physiology and Biophysics, Federal University of Minas Gerais (UFMG), 31270-010 Belo Horizonte, Minas Gerais, Brazil
| | - Qamar Javed
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan; Department of Molecular Biology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan.
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Vascular Response to Graded Angiotensin II Infusion in Offspring Subjected to High-Salt Drinking Water during Pregnancy: The Effect of Blood Pressure, Heart Rate, Urine Output, Endothelial Permeability, and Gender. Int J Vasc Med 2014; 2014:876527. [PMID: 24860669 PMCID: PMC4016930 DOI: 10.1155/2014/876527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Rennin-angiotensin system and salt diet play important roles in blood pressure control. We hypothesized that the high-salt intake during pregnancy influences the degree of angiotensin-dependent control of the blood pressure in adult offspring. Methods. Female Wistar rats in two groups (A and B) were subjected to drink tap and salt water, respectively, during pregnancy. The offspring were divided into four groups as male and female offspring from group A (groups 1 and 2) and from group B (groups 3 and 4). In anesthetized matured offspring mean arterial pressure (MAP), heart rate and urine output were measured in response to angiotensin II (AngII) (0-1000 ng/kg/min, iv) infusion. Results. An increase in MAP was detected in mothers with salt drinking water (P < 0.05). The body weight increased and kidney weight decreased significantly in male offspring from group 3 in comparison to group 1 (P < 0.05). MAP and urine volume in response to AngII infusion increased in group 3 (P < 0.05). These findings were not observed in female rats. Conclusion. Salt overloading during pregnancy had long-term effects on kidney weight and increased sex-dependent response to AngII infusion in offspring (adult) that may reveal the important role of diet during pregnancy in AngII receptors.
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30
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Zhao Z, Wang H, Jessup JA, Lindsey SH, Chappell MC, Groban L. Role of estrogen in diastolic dysfunction. Am J Physiol Heart Circ Physiol 2014; 306:H628-40. [PMID: 24414072 DOI: 10.1152/ajpheart.00859.2013] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The prevalence of left ventricular diastolic dysfunction (LVDD) sharply increases in women after menopause and may lead to heart failure. While evidence suggests that estrogens protect the premenopausal heart from hypertension and ventricular remodeling, the specific mechanisms involved remain elusive. Moreover, whether there is a protective role of estrogens against cardiovascular disease, and specifically LVDD, continues to be controversial. Clinical and basic science have implicated activation of the renin-angiotensin-aldosterone system (RAAS), linked to the loss of ovarian estrogens, in the pathogenesis of postmenopausal diastolic dysfunction. As a consequence of increased tissue ANG II and low estrogen, a maladaptive nitric oxide synthase (NOS) system produces ROS that contribute to female sex-specific hypertensive heart disease. Recent insights from rodent models that mimic the cardiac phenotype of an estrogen-insufficient or -deficient woman (e.g., premature ovarian failure or postmenopausal), including the ovariectomized congenic mRen2.Lewis female rat, provide evidence showing that estrogen modulates the tissue RAAS and NOS system and related intracellular signaling pathways, in part via the membrane G protein-coupled receptor 30 (GPR30; also called G protein-coupled estrogen receptor 1). Complementing the cardiovascular research in this field, the echocardiographic correlates of LVDD as well as inherent limitations to its use in preclinical rodent studies will be briefly presented. Understanding the roles of estrogen and GPR30, their interactions with the local RAAS and NOS system, and the relationship of each of these to LVDD is necessary to identify new therapeutic targets and alternative treatments for diastolic heart failure that achieve the cardiovascular benefits of estrogen replacement without its side effects and contraindications.
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Affiliation(s)
- Zhuo Zhao
- Department of Cardiology, Jinan Central Hospital, Affiliated with Shandong University, Jinan, China
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31
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Bhatia K, Zimmerman MA, Sullivan JC. Sex differences in angiotensin-converting enzyme modulation of Ang (1-7) levels in normotensive WKY rats. Am J Hypertens 2013; 26:591-8. [PMID: 23547034 DOI: 10.1093/ajh/hps088] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Levels of the vasodilatory peptide angiotensin (Ang) (1-7) have been reported to be greater in females than in males, although the molecular mechanism responsible for this is unknown. Angiotensin-converting enzyme (ACE), ACE2, and neprilysin are key enzymes regulating Ang (1-7) formation. We conducted a study to determine the effect of sex on the activities of ACE, ACE2, and neprilysin in the kidneys of normotensive rats. We hypothesized that greater ACE2 or neprilysin activity in females would result in enhanced Ang (1-7) formation as compared with that in males. METHODS We measured the enzymatic activities of ACE, ACE2, and neprilysin in the renal cortex and medulla of 12-week-old male and female WKY rats. We treated additional rats with vehicle or enalapril (10 mg/kg/day in drinking water) for 14 days, and measured their Ang II and Ang (1-7) levels. RESULTS Renal cortical activity of ACE was greater in female than in male WKY rats (P < 0.05), but the activity of ACE in the renal medulla was not significantly different in the two sexes. Renal cortical and medullary ACE2 and neprilysin activities were comparable in male and female WKY rats. Treatment with enalapril significantly decreased Ang II levels in the renal cortex and medulla of male and female WKY rats as compared with those in vehicle-treated controls (P < 0.05); enalapril did not change the plasma levels of Ang II. Cortical levels of Ang (1-7) were higher in vehicle-treated females than in vehicle-treated males (P < 0.05), and treatment with enalapril decreased Ang (1-7) levels only in females (P < 0.05). CONCLUSIONS Our data supports a role for ACE in the formation of renal cortical Ang (1-7) in female WKY rats that is absent in males.
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Affiliation(s)
- Kanchan Bhatia
- Department of Medicine, Georgia Health Sciences University, Augusta, GA, USA
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Seeland U, Regitz-Zagrosek V. Sex and gender differences in cardiovascular drug therapy. Handb Exp Pharmacol 2013:211-36. [PMID: 23027453 DOI: 10.1007/978-3-642-30726-3_11] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This chapter outlines sex differences in pharmacokinetics and pharmacodynamics of the most frequently used drugs in cardiovascular diseases, e.g., coronary artery disease, hypertension, heart failure. Retrospective analysis of previously published drug trials revealed marked sex differences in efficacy and adverse effects in a number of cardiovascular drugs. This includes a higher mortality among women taking digoxin for heart failure, more torsade de pointes arrhythmia in QT prolonging drugs and more cough with ACE inhibitors. Trends towards a greater benefit for women and/or female animals have been observed in some studies for endothelin receptor antagonists, the calcium channel blocker amlodipine, the ACE-inhibitor ramipril and the aldosterone antagonist eplerenone. However, reproduction of these results in independent studies and solid statistical evidence is still lacking. Some drugs require a particularly careful dose adaptation in women: the beta-blocker metoprolol, the calcium channel blocker verapamil, loop-, and thiazide diuretics. In conclusion, sex differences in pharmacokinetics and pharmacodynamics have to be taken into account for cardiovascular drug therapy in women.
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Affiliation(s)
- Ute Seeland
- Institute of Gender in Medicine, Universitaetsmedizin Berlin Charité, Berlin, Germany
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Gupte M, Thatcher SE, Boustany-Kari CM, Shoemaker R, Yiannikouris F, Zhang X, Karounos M, Cassis LA. Angiotensin converting enzyme 2 contributes to sex differences in the development of obesity hypertension in C57BL/6 mice. Arterioscler Thromb Vasc Biol 2012; 32:1392-9. [PMID: 22460555 DOI: 10.1161/atvbaha.112.248559] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Obesity promotes hypertension, but it is unclear if sex differences exist in obesity-related hypertension. Angiotensin converting enzyme 2 (ACE2) converts angiotensin II (AngII) to angiotensin-(1-7) (Ang-[1-7]), controlling peptide balance. We hypothesized that tissue-specific regulation of ACE2 by high-fat (HF) feeding and sex hormones contributes to sex differences in obesity-hypertension. METHODS AND RESULTS HF-fed females gained more body weight and fat mass than males. HF-fed males exhibiting reduced kidney ACE2 activity had increased plasma angiotensin II levels and decreased plasma Ang-(1-7) levels. In contrast, HF-fed females exhibiting elevated adipose ACE2 activity had increased plasma Ang-(1-7) levels. HF-fed males had elevated systolic and diastolic blood pressure that were abolished by losartan. In contrast, HF-fed females did not exhibit increased systolic blood pressure until females were administered the Ang-(1-7) receptor antagonist, D-Ala-Ang-(1-7). Deficiency of ACE2 increased systolic blood pressure in HF-fed males and females, which was abolished by losartan. Ovariectomy of HF-fed female mice reduced adipose ACE2 activity and plasma Ang-(1-7) levels, and promoted obesity-hypertension. Finally, estrogen, but not other sex hormones, increased adipocyte ACE2 mRNA abundance. CONCLUSIONS These results demonstrate that tissue-specific regulation of ACE2 by diet and sex hormones contributes to sex differences in obesity-hypertension.
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Affiliation(s)
- Manisha Gupte
- Graduate Center for Nutritional Sciences, University of Kentucky, Room 521b, Wethington Building, 900 S. Limestone, Lexington, KY 40536-0200, USA
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Sampson AK, Jennings GLR, Chin-Dusting JPF. Y are males so difficult to understand?: a case where "X" does not mark the spot. Hypertension 2012; 59:525-31. [PMID: 22291445 DOI: 10.1161/hypertensionaha.111.187880] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Amanda K Sampson
- Vascular Pharmacology, Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria, 3004 Australia.
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Sex-related differences in pharmacokinetics and pharmacodynamics of anti-hypertensive drugs. Hypertens Res 2011; 35:245-50. [DOI: 10.1038/hr.2011.189] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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36
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Li Y, Yang P, Wu S, Yuan J, Shen C, Wu Y, Zhao D, Ren Q, Feng F, Guan W. Gender-specific association between ACE gene I/D polymorphism and blood pressure response to hydrochlorothiazide in Han Chinese hypertensive patients. Biochem Genet 2011; 49:704-14. [PMID: 21647824 DOI: 10.1007/s10528-011-9444-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
To evaluate the interaction between the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and gender with individual blood pressure response to hydrochlorothiazide (HCTZ) in hypertensives, we enrolled 829 mild-moderate hypertensive patients. All subjects were given HCTZ (12.5 mg) orally each day for 6 weeks. A total of 776 patients completed the study. There was statistically significant interaction between the effects of genotype and gender on systolic (P = 0.002) and diastolic (P = 0.048) response after adjusting for covariables. Moreover, in each gender, the genotype that was associated with the greatest blood pressure response to HCTZ (DD homozygotes in men and II homozygotes in women) was also associated with the greatest increase in serum ACE activity in response to HCTZ. The results suggest that the I/D polymorphism of the ACE gene is associated with interindividual differences in the blood pressure response to a low dose of a diuretic in a gender-specific manner in the Han Chinese population with hypertension.
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Affiliation(s)
- Yun Li
- School of Public Health, Hebei United University, Tangshan 063007, China.
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Komukai K, Mochizuki S, Yoshimura M. Gender and the renin-angiotensin-aldosterone system. Fundam Clin Pharmacol 2011; 24:687-98. [PMID: 20608988 DOI: 10.1111/j.1472-8206.2010.00854.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Premenopausal women are protected to some extent from cardiovascular and kidney diseases. Because this protection weakens after menopause, sex hormones are believed to play an important role in the pathogenesis of cardiovascular and kidney diseases. The cardiovascular system and the kidneys are regulated by the renin-angiotensin-aldosterone system (RAAS), which in turn, appears to be regulated by sex hormones. In general, oestrogen increases angiotensinogen levels and decreases renin levels, angiotensin-converting enzyme (ACE) activity, AT(1) receptor density, and aldosterone production. Oestrogen also activates counterparts of the RAAS such as natriuretic peptides, AT(2) receptor density, and angiotensinogen (1-7). Progesterone competes with aldosterone for mineralocorticoid receptor. Less is known about androgens, but testosterone seems to increase renin levels and ACE activity. These effects of sex hormones on the RAAS can explain at least some of the gender differences in cardiovascular and kidney diseases.
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Affiliation(s)
- Kimiaki Komukai
- Division of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Venegas-Pont M, Sartori-Valinotti JC, Glover PH, Reckelhoff JF, Ryan MJ. Sexual dimorphism in the blood pressure response to angiotensin II in mice after angiotensin-converting enzyme blockade. Am J Hypertens 2010; 23:92-6. [PMID: 19893496 DOI: 10.1038/ajh.2009.203] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The incidence of hypertension and progression of renal disease are greater in men than in women. Data suggest that there is a dimorphic response to angiotensin II (Ang II) in rats, with male rats exhibiting a greater increase in mean arterial pressure (MAP) than females. However, during endogenous renin-angiotensin system (RAS) blockade with angiotensin-converting enzyme (ACE) inhibition, female rats have a greater MAP response to Ang II. We tested whether female mice exhibit a greater MAP response to chronic Ang II during ACE inhibition. METHODS Twenty-week-old male and female C57BL/6J mice (n > or = 6/group), treated with enalapril (40 mg/kg/day in drinking water), were assigned to groups receiving either Ang II (800 ng/kg/min) or saline for 2 weeks. Enalapril treatment began 4 days before and continued throughout the experiment. RESULTS MAP was higher in male mice than female mice treated with enalapril and Ang II (male: 144 +/- 3 vs. female: 121 +/- 6 mm Hg, P < 0.05) and was not different between mice treated with enalapril alone (male: 99 +/- 3 vs. female: 100 +/- 3 mm Hg). F2-isoprostanes were not increased by Ang II; however, female mice had significantly higher levels than males. Renal cortical expression of catalase and Cu/Zn-superoxide dismutase (SOD) was not different between experimental groups. Urinary protein was higher in male mice when compared to females, but was not changed after treatment with Ang II in either group. CONCLUSIONS These data suggest that there are species and sex-specific differences in the mechanism of the blood pressure response to Ang II, even during ACE inhibition.
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Sullivan JC. Sex and the renin-angiotensin system: inequality between the sexes in response to RAS stimulation and inhibition. Am J Physiol Regul Integr Comp Physiol 2008; 294:R1220-6. [PMID: 18287217 DOI: 10.1152/ajpregu.00864.2007] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of this review is to examine sex differences in response to stimulation and inhibition of the renin-angiotensin system (RAS). The RAS plays a prominent role in the development of chronic renal disease, and there are known sex differences not only in the expression level of components of the RAS but also in how males and females respond to perturbations of the RAS. In men, renal injury increases in parallel with increased activation of the RAS, while in women, increases in ANG II do not necessarily translate into increases in renal injury. Moreover, both epidemiological and experimental studies have noted sex differences in the therapeutic benefits following angiotensin-converting enzyme inhibitor and angiotensin receptor blocker treatment. Despite these differences, RAS inhibitors are the most commonly prescribed drugs for the treatment of chronic renal disease, irrespective of sex. This review will examine how males and females respond to stimulation and inhibition of the RAS, with a focus on renal disease.
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Affiliation(s)
- Jennifer C Sullivan
- Vascular Biology Center, Medical College of Georgia, Augusta, GA 30912, USA.
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Sartori-Valinotti JC, Iliescu R, Yanes LL, Dorsett-Martin W, Reckelhoff JF. Sex differences in the pressor response to angiotensin II when the endogenous renin-angiotensin system is blocked. Hypertension 2008; 51:1170-6. [PMID: 18259017 DOI: 10.1161/hypertensionaha.107.106922] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study determined whether there are sex differences in the pressor response to angiotensin II (Ang II) when the endogenous renin-angiotensin system (RAS) is blocked by enalapril (ACEI), and whether this pressor response is changed in the presence of high salt (HS). Telemetry BP was measured in rats treated with ACEI (250 mg/L drinking water) (n=6 to 7/grp), or with ACEI and Ang II (150 ng/kg/min, sc; n=5 to 6/grp), for 3 wk. For the last 2 wk of the study, rats received HS (4% NaCl). MAP was lower in females during baseline (100.8+/-1.1 versus 105.2+/-1.3; P<0.05), and with ACEI the last 3 days on normal salt diet (78.8+/-1.2 versus 88.5+/-0.9; P<0.05), but increased to higher levels than in males on day 6 of Ang II (129.0+/-2.2 versus 117.3+/-2.9; P<0.05). One week of Ang II increased albuminuria in males, but not females, and urinary 8-iso-PGF2alpha (F2-isoP) was not increased in either males or females. MAP was salt-sensitive in both sexes receiving ACEI, but was only salt-sensitive in males with Ang II (129.3+/-3.7 versus 145.1+/-5.7; P<0.05). Albuminuria continued to increase with HS and Ang II in males, but not in females. F2-isoP excretion increased with MAP during the last week of HS and Ang II in males but was independent of MAP in females. With ACEI, MAP in females on normal salt is more responsive to Ang II but is independent of oxidative stress or renal injury. MAP in males is salt-sensitive with Ang II, which may be mediated by oxidative stress and renal injury.
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Affiliation(s)
- Julio C Sartori-Valinotti
- Department of Physiology and Biophysics, The Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA
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Sullivan JC, Semprun-Prieto L, Boesen EI, Pollock DM, Pollock JS. Sex and sex hormones influence the development of albuminuria and renal macrophage infiltration in spontaneously hypertensive rats. Am J Physiol Regul Integr Comp Physiol 2007; 293:R1573-9. [PMID: 17699561 DOI: 10.1152/ajpregu.00429.2007] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is a sex difference in hypertensive renal injury, with men experiencing greater severity and a more rapid progression of renal disease than women; however, the molecular mechanisms protecting against renal injury in women are unknown. The goal of this study was to determine whether sex hormones modulate blood pressure and the progression of albuminuria during the developmental phase of hypertension in male and female spontaneously hypertensive rats (SHR). Studies were also performed to examine how sex and sex hormones influence two major risk factors for albuminuria, overactivation of the renin-angiotensin system and oxidative stress. Blood pressure was measured by telemetry in gonad-intact and gonadectomized male and female SHR. Microalbumin excretion, measured over time, and macrophage infiltration were used to assess renal health. Male SHR had significantly higher blood pressures than female SHR, and gonadectomy decreased blood pressures in males with no effect in females. Male SHR displayed a gonad-sensitive increase in albuminuria over time, and female SHR had a gonad-sensitive suppression in macrophage infiltration. Female SHR had greater plasma ANG II levels and similar levels of renal cortical ANG II vs. levels shown in males but less AT(1)-receptor protein expression in the renal cortex. Female SHR also had a gonad-sensitive decrease in renal oxidative stress. Therefore, the renal protection afforded to female SHR is associated with lower blood pressure, decreased macrophage infiltration, and decreased levels of oxidative stress.
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Affiliation(s)
- Jennifer C Sullivan
- Vascular Biology Center, Medical College of Georgia, 1459 Laney Walker Blvd, Augusta, GA 30912, USA.
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