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Afsar B, Afsar RE, Caliskan Y, Lentine KL, Edwards JC. Renin angiotensin system-induced muscle wasting: putative mechanisms and implications for clinicians. Mol Cell Biochem 2024:10.1007/s11010-024-05043-8. [PMID: 38811433 DOI: 10.1007/s11010-024-05043-8] [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: 02/25/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
Renin angiotensin system (RAS) alters various mechanisms related to muscle wasting. The RAS system consists of classical and non-classical pathways, which mostly function differently. Classical RAS pathway, operates through angiotensin II (AngII) and angiotensin type 1 receptors, is associated with muscle wasting and sarcopenia. On the other hand, the non-classical RAS pathway, which operates through angiotensin 1-7 and Mas receptor, is protective against sarcopenia. The classical RAS pathway might induce muscle wasting by variety of mechanisms. AngII reduces body weight, via reduction in food intake, possibly by decreasing hypothalamic expression of orexin and neuropeptide Y, insulin like growth factor-1 (IGF-1) and mammalian target of rapamycin (mTOR), signaling, AngII increases skeletal muscle proteolysis by forkhead box transcription factors (FOXO), caspase activation and muscle RING-finger protein-1 transcription. Furthermore, AngII infusion in skeletal muscle reduces phospho-Bad (Ser136) expression and induces apoptosis through increased cytochrome c release and DNA fragmentation. Additionally, Renin angiotensin system activation through AT1R and AngII stimulates tumor necrosis factor-α, and interleukin-6 which induces muscle wasting, Last but not least classical RAS pathway, induce oxidative stress, disturb mitochondrial energy metabolism, and muscle satellite cells which all lead to muscle wasting and decrease muscle regeneration. On the contrary, the non-classical RAS pathway functions oppositely to mitigate these mechanisms and protects against muscle wasting. In this review, we summarize the mechanisms of RAS-induced muscle wasting and putative implications for clinical practice. We also emphasize the areas of uncertainties and suggest potential research areas.
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Affiliation(s)
- Baris Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey.
- Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO, USA.
| | - Rengin Elsurer Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
- Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Yasar Caliskan
- Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Krista L Lentine
- Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - John C Edwards
- Division of Nephrology, School of Medicine, Saint Louis University, St. Louis, MO, USA
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Sutovska H, Molcan L, Majzunova M, Sykora M, Kopkan L, Zeman M. Mineralocorticoid receptor blockade protects the kidneys but does not affect inverted blood pressure rhythm in hypertensive transgenic (mRen-2)27 rats. Mol Cell Endocrinol 2023; 572:111967. [PMID: 37210027 DOI: 10.1016/j.mce.2023.111967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/17/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
Aldosterone regulates blood pressure (BP) through water and sodium balance. In our study, we studied if continuous treatment with a mineralocorticoid receptor antagonist, spironolactone (30 mg/kg/day) for 20 days can: 1) attenuate hypertension development and restore inverted 24-h BP rhythm in hypertensive transgenic (mRen-2)27 rats (TGR) measured by telemetry; 2) improve function of the kidneys and heart; 3) be protective against high salt load (1% in water) by mitigating oxidative injury and improving kidney function. Spironolactone decreased albuminuria and 8-isoprostane in normal and salt load conditions in BP-independent effects. Salt load increased BP, impaired autonomic balance, suppressed plasma aldosterone level and increased natriuresis, albuminuria and oxidative injury in TGR. Spironolactone did not restore the inverted 24-h rhythm of BP in TGR, therefore, mineralocorticoids are not crucial in regulation of BP daily profile. Spironolactone improved kidney function, decreased oxidative stress and was protective against high salt load in the BP-independent manner.
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Affiliation(s)
- Hana Sutovska
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic.
| | - Lubos Molcan
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic.
| | - Miroslava Majzunova
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic.
| | - Matus Sykora
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic.
| | - Libor Kopkan
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - Michal Zeman
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic.
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Moustaki M, Paschou SA, Vakali EC, Vryonidou A. Secondary diabetes mellitus due to primary aldosteronism. Endocrine 2023; 79:17-30. [PMID: 36001240 DOI: 10.1007/s12020-022-03168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/07/2022] [Indexed: 01/07/2023]
Abstract
Primary aldosteronism (PA) and diabetes mellitus (DM) are clinical conditions that increase cardiovascular risk. Approximately one in five patients with PA have DM. Nevertheless, the pathophysiology linking these two entities is not entirely understood. In addition, the majority of patients with PA have glucocorticoid co-secretion, which is associated with increased risk of impaired glucose homeostasis. In the present review, we aim to comprehensively discuss all the available research data concerning the interplay between mineralocorticoid excess and glucose metabolism, with separate analysis of the sequalae in muscle, adipose tissue, liver and pancreas. Aldosterone binds both mineralocorticoid and glucocorticoid receptors and amplifies tissue glucocorticoid activity, via 11-β-hydroxysteroid dehydrogenase type 1 stimulation. A clear classification of the molecular events as per specific receptor in insulin-sensitive tissues is impossible, while their synergistic interaction is plausible. Furthermore, aldosterone induces oxidative stress and inflammation, perturbs adipokine expression, thermogenesis and lipogenesis in adipose tissue, and increases hepatic steatosis. In pancreas, enhanced oxidative stress and inflammation of beta cells, predominantly upon glucocorticoid receptor activation, impair insulin secretion. No causality between hypokalemia and impaired insulin response is yet proven; in contrast, hypokalemia appears to be implicated with insulin resistance and hepatic steatosis. The superior efficacy of adrenalectomy in ameliorating glucose metabolism vs. mineralocorticoid receptor antagonists in clinical studies highlights the contribution of non-mineralocorticoid receptor-mediated mechanisms in the pathophysiologic process. The exact role of hypokalemia, the mechanisms linking mineralocorticoid excess with hepatic steatosis, and possible disease-modifying role of pioglitazone warrant further studies.
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Affiliation(s)
- Melpomeni Moustaki
- Department of Endocrinology and Diabetes Centre, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Eleni C Vakali
- Department of Endocrinology and Diabetes Centre, Hellenic Red Cross Hospital, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Centre, Hellenic Red Cross Hospital, Athens, Greece
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Hulse JL, Habibi J, Igbekele AE, Zhang B, Li J, Whaley-Connell A, Sowers JR, Jia G. Mineralocorticoid Receptors Mediate Diet-Induced Lipid Infiltration of Skeletal Muscle and Insulin Resistance. Endocrinology 2022; 163:bqac145. [PMID: 36039677 PMCID: PMC10233286 DOI: 10.1210/endocr/bqac145] [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: 05/13/2022] [Indexed: 11/19/2022]
Abstract
Excess circulating lipids increase total intramyocellular (IMC) lipid content and ectopic fat storage, resulting in lipotoxicity and insulin resistance in skeletal muscle. Consumption of a diet high in fat and refined sugars-a Western diet (WD)-has been shown to activate mineralocorticoid receptors (MRs) and promote insulin resistance. However, our understanding of the precise mechanisms by which enhanced MR activation promotes skeletal muscle insulin resistance remains unclear. In this study, we investigated the mechanisms by which enhanced MR signaling in soleus muscle promotes ectopic skeletal muscle lipid accumulation and related insulin resistance. Six-week-old C57BL/6J mice were fed either a mouse chow diet or a WD with or without spironolactone (1 mg/kg/day) for 16 weeks. Spironolactone attenuated 16 weeks of WD-induced in vivo glucose intolerance and insulin resistance, and improved soleus insulin metabolic signaling. Improved insulin sensitivity was accompanied by increased glucose transporter 4 (Glut4) expression in conjunction with decreased soleus free fatty acid and IMC lipid content, as well as CD36 expression. Additionally, spironolactone prevented WD-induced soleus mitochondria dysfunction. Furthermore, MR signaling also mediated WD/aldosterone-induced reductions in soleus microRNA (miR)-99a, which was identified to negatively target CD36 and prevented palmitic acid-induced increases in CD36 expression, lipid droplet formation, mitochondria dysfunction, and insulin resistance in C2C12 cells. These data indicate that inhibition of MR activation with spironolactone prevented diet-induced abnormal expression of miR-99a, which had the capacity to reduce CD36, leading to reduced IMC lipid content and improved soleus mitochondria function and insulin sensitivity.
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Affiliation(s)
- Jack L Hulse
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201, USA
| | - Javad Habibi
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201, USA
| | - Aderonke E Igbekele
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Bingyue Zhang
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Jessie Li
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Adam Whaley-Connell
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201, USA
- Department of Medicine—Nephrology and Hypertension, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - James R Sowers
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201, USA
- Department of Medicine—Nephrology and Hypertension, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65212, USA
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Guanghong Jia
- Department of Medicine—Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65212, USA
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5
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Habibi J, Chen D, Hulse JL, Whaley-Connell A, Sowers JR, Jia G. Targeting mineralocorticoid receptors in diet-induced hepatic steatosis and insulin resistance. Am J Physiol Regul Integr Comp Physiol 2022; 322:R253-R262. [PMID: 35107025 PMCID: PMC8896998 DOI: 10.1152/ajpregu.00316.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mineralocorticoid receptor (MR) activation plays an important role in hepatic insulin resistance. However, the precise mechanisms by which MR activation promotes hepatic insulin resistance remains unclear. Therefore, we sought to investigate the roles and mechanisms by which MR activation promotes Western diet (WD)-induced hepatic steatosis and insulin resistance. Six-week-old C57BL6J mice were fed either mouse chow or a WD, high in saturated fat and refined carbohydrates, with or without the MR antagonist spironolactone (1 mg/kg/day) for 16 wk. WD feeding resulted in systemic insulin resistance at 8 and 16 wk. WD also induced impaired hepatic insulin metabolic signaling via phosphoinositide 3-kinases/protein kinase B pathways, which was associated with increased hepatic CD36, fatty acid transport proteins, fatty acid-binding protein-1, and hepatic steatosis. Meanwhile, consumption of a WD-induced hepatic mitochondria dysfunction, oxidative stress, and inflammatory responses. These abnormalities occurring in response to WD feeding were blunted with spironolactone treatment. Moreover, spironolactone promoted white adipose tissue browning and hepatic glucose transporter type 4 expression. These data suggest that enhanced hepatic MR signaling mediates diet-induced hepatic steatosis and dysregulation of adipose tissue browning, and subsequent hepatic mitochondria dysfunction, oxidative stress, inflammation, as well as hepatic insulin resistance.
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Affiliation(s)
- Javad Habibi
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,3Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri
| | - Dongqing Chen
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,3Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri
| | - Jack L. Hulse
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,3Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri
| | - Adam Whaley-Connell
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,2Division of Nephrology and Hypertension, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,3Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri
| | - James R. Sowers
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,2Division of Nephrology and Hypertension, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,3Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri,4Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri,5Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri
| | - Guanghong Jia
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri,3Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri,4Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
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Kang B, Peng C, Wang K, Song Y, Yang Y, Ma L, Mei M, Hu J, Yang S, Wu FF, Li Q. Elevated Myoglobin in Patients With Primary Aldosteronism: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:799174. [PMID: 35265036 PMCID: PMC8899019 DOI: 10.3389/fendo.2022.799174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Primary aldosteronism (PA) is characterized by the autonomous excessive production of aldosterone in the adrenal cortex. Aldosterone is associated with damages to heart muscle and skeletal muscle. The purpose of this study was to evaluate serum levels of muscle injury markers and their associated factors in patients with primary aldosteronism. METHODS We retrospectively enrolled subjects with PA and essential hypertension (EH) who had completed testing for serum high sensitivity troponin T (hs-TnT), creatine kinase isoenzyme MB (CK-MB) and myoglobin from the database of the Chongqing Primary Aldosteronism Study (CONPASS). Univariate and multivariate linear regression analyses were performed to analyze the influencing factors of myocardial injury markers. RESULTS In total, 278 patients with PA and 445 patients with EH were enrolled in this study. Compared with EH patients, serum concentrations of hs-TnT [7.0 (4.0-12.0) vs. 6.0 (3.0-11.0) ng/L; p=0.005] and myoglobin [24.2 (21.0-38.1) vs. 21.8 (21.0-31.9) μg/L; p=0.023] were significantly higher among PA patients, while no significant difference of CK-MB was found between two groups [1.4 (1.0-2.0) vs. 1.3 (0.9-1.9) μg/L; p=0.154]. Univariate linear regression analysis showed that myoglobin was negatively correlated with serum potassium (β=-0.31; p<0.01) and positively correlated with plasma aldosterone concentration (β=0.40; p<0.01) in the PA group, while no significant correlation was found between hs-TnT and biochemical parameters. After adjusting for multiple confounders, myoglobin was negatively correlated with serum potassium (β=-0.15; p<0.05) and positively correlated with plasma aldosterone concentration (β=0.34; p<0.01) in the PA group. CONCLUSIONS The serum level of myoglobin was significantly increased in PA patients, and myoglobin was independently correlated with plasma aldosterone concentration.
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Affiliation(s)
- Bing Kang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Peng
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kanran Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Song
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linqiang Ma
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Mei
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei-Fei Wu
- Department of Endocrinology, Affiliated Heping Hospital, Changzhi Medical College, Changzhi, China
- *Correspondence: Qifu Li, ; Fei-Fei Wu,
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qifu Li, ; Fei-Fei Wu,
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Koorneef LL, van der Meulen M, Kooijman S, Sánchez-López E, Scheerstra JF, Voorhoeve MC, Ramesh ANN, Rensen PCN, Giera M, Kroon J, Meijer OC. Dexamethasone-associated metabolic effects in male mice are partially caused by depletion of endogenous corticosterone. Front Endocrinol (Lausanne) 2022; 13:960279. [PMID: 36034417 PMCID: PMC9399852 DOI: 10.3389/fendo.2022.960279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Synthetic glucocorticoids are clinically used to treat auto-immune and inflammatory disease. Despite the high efficacy, glucocorticoid treatments causes side effects such as obesity and insulin resistance in many patients. Via their pharmacological target, the glucocorticoid receptor (GR), glucocorticoids suppress endogenous glucocorticoid secretion. Endogenous, but not synthetic, glucocorticoids activate the mineralocorticoid receptor (MR) and side effects of synthetic glucocorticoids may thus not only result from GR hyperactivation but also from MR hypoactivation. Here, we tested the hypothesis that reactivation of MR with corticosterone add-on treatment can attenuate the metabolic effects of the synthetic glucocorticoid dexamethasone. Male 8-week-old C57Bl/6J mice received a high-fat diet supplemented with dexamethasone or vehicle, and were subcutaneously implanted with low-dose corticosterone- or vehicle-containing pellets. Dexamethasone strongly reduced body weight and fat mass gain, while corticosterone add-on partially normalized this. Dexamethasone-induced hyperglycemia and hyperinsulinemia were exacerbated by corticosterone add-on, which was prevented by MR antagonism. In subcutaneous white adipose tissue, corticosterone add-on prevented the dexamethasone-induced expression of intracellular lipolysis genes. In brown adipose tissue, dexamethasone also upregulated gene expression of brown adipose tissue identity markers, lipid transporters and lipolysis enzymes, which was prevented by corticosterone add-on. In conclusion, corticosterone add-on treatment prevents several, while exacerbating other metabolic effects of dexamethasone. While the exact role of MR remains elusive, this study suggests that corticosterone suppression by dexamethasone contributes to its effects in mice.
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Affiliation(s)
- Lisa L. Koorneef
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Merel van der Meulen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Sander Kooijman
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Elena Sánchez-López
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Jari F. Scheerstra
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Maaike C. Voorhoeve
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Ajith N. Nadamuni Ramesh
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Patrick C. N. Rensen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Jan Kroon
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Onno C. Meijer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Onno C. Meijer,
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Lee JY, Kim DA, Choi E, Lee YS, Park SJ, Kim BJ. Aldosterone Inhibits In Vitro Myogenesis by Increasing Intracellular Oxidative Stress via Mineralocorticoid Receptor. Endocrinol Metab (Seoul) 2021; 36:865-874. [PMID: 34325504 PMCID: PMC8419622 DOI: 10.3803/enm.2021.1108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite clinical evidence indicating poor muscle health in subjects with primary aldosteronism (PA), it is still unclear whether the role of aldosterone in muscle metabolism is direct or mediated indirectly via factors, such as electrolyte imbalance or impaired glucose uptake. As one approach to clarify this issue, we investigated the effect of aldosterone on in vitro myogenesis and the potential mechanism explaining it. METHODS Myogenesis was induced in mouse C2C12 myoblasts with 2% horse serum. Immunofluorescence, quantitative reversetranscription polymerase chain reaction, Western blot, viability, and migration analyses were performed for experimental research. RESULTS Recombinant aldosterone treatment suppressed muscle differentiation from mouse C2C12 myoblasts in a dose-dependent manner, and consistently reduced the expression of myogenic differentiation markers. Furthermore, aldosterone significantly increased intracellular reactive oxygen species (ROS) levels in myotubes, and treatment with N-acetyl cysteine, a potent biological thiol antioxidant, reversed the decrease of myotube area, myotube area per myotube, nucleus number per myotube, and fusion index due to aldosterone through decreasing oxidative stress. A binding enzyme-linked immunosorbent assay confirmed that mineralocorticoid receptor (MR) interacted with aldosterone in C2C12 myoblasts, while eplerenone, an MR inhibitor, blocked aldosterone-stimulated intracellular ROS generation during myogenesis and markedly attenuated the suppression of in vitro myogenesis by aldosterone. CONCLUSION These findings support the hypothesis that hypersecretion of aldosterone, like PA, directly contributes to muscular deterioration and suggest that antioxidants and/or MR antagonists could be effective therapeutic options to reduce the risk of sarcopenia in these patients.
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Affiliation(s)
- Jin Young Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul,
Korea
| | - Da Ae Kim
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul,
Korea
| | - Eunah Choi
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul,
Korea
| | - Yun Sun Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul,
Korea
| | - So Jeong Park
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul,
Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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Grewal S, Fosam A, Chalk L, Deven A, Suzuki M, Correa RR, Blau JE, Demidowich AP, Stratakis CA, Muniyappa R. Insulin sensitivity and pancreatic β-cell function in patients with primary aldosteronism. Endocrine 2021; 72:96-103. [PMID: 33462741 PMCID: PMC8087621 DOI: 10.1007/s12020-020-02576-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary aldosteronism (PA) is associated with an increased risk for dysglycemia. However, the effects of hyperaldosteronism on insulin sensitivity and β-cell function are unclear. METHODS Using a cross-sectional study design, we assessed insulin sensitivity and pancreatic β-cell function from an oral glucose tolerance test (OGTT) in patients from two cohorts: subjects with PA (n = 21) and essential hypertension control (EHC) subjects (n = 22). Age, sex, BMI, and mean arterial pressure adjusted measures of insulin sensitivity and β-cell function were compared between the groups. RESULTS PA individuals were less insulin sensitive compared to EHC subjects (Quantitative insulin sensitivity check index [QUICKI]: 0.340 ± 0.006 vs. 0.374 ± 0.013, p < 0.001; Matsuda index: 4.14 ± 0.49 vs. 7.87 ± 1.42, p < 0.001; SI: 11.45 ± 4.85 vs. 21.23 ± 6.11 dL/kg/min per μU/mL, p = 0.02). The hepatic insulin resistance index (HIRI) was higher in PA subjects (PA: 5.61 ± 1.01 vs. EHC: 4.13 ± 0.61, p = 0.002). The insulinogenic index (IGI), an index of β-cell function was higher in the PA cohort (PA: 1.49 ± 0.27 vs. 1.11 ± 0.21 μU/mL/mg/dL, p = 0.03). However, the oral disposition index (DI) was similar between the groups (PA: 4.77 ± 0.73 vs. EHC: 5.46 ± 0.85, p = 0.42), which likely accounts for the similar glucose tolerance between the two cohorts, despite lower sensitivity. CONCLUSIONS In summary, insulin sensitivity is significantly lower in PA with an appropriately compensated β-cell function. These results suggest that excess aldosterone and/or other steroids in the context of PA may negatively affect insulin action without adversely impacting β-cell function.
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Affiliation(s)
- Shivraj Grewal
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andin Fosam
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Liam Chalk
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Arjun Deven
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mari Suzuki
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ricardo Rafael Correa
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jenny E Blau
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Paul Demidowich
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Constantine A Stratakis
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
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Jia G, Lockette W, Sowers JR. Mineralocorticoid receptors in the pathogenesis of insulin resistance and related disorders: from basic studies to clinical disease. Am J Physiol Regul Integr Comp Physiol 2021; 320:R276-R286. [PMID: 33438511 DOI: 10.1152/ajpregu.00280.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aldosterone is a steroid hormone that regulates blood pressure and cardiovascular function by acting on renal and vascular mineralocorticoid receptors (MRs) to promote sodium retention and modulate endothelial function. Indeed, MRs are expressed in endothelial cells, vascular smooth muscle cells, adipocytes, immune cells, skeletal muscle cells, and cardiomyocytes. Excessive aldosterone and associated MR activation impair insulin secretion, insulin metabolic signaling to promote development of diabetes, and the related cardiometabolic syndrome. These adverse effects of aldosterone are mediated, in part, via increased inflammation, oxidative stress, dyslipidemia, and ectopic fat deposition. Therefore, inhibition of MR activation may have a beneficial effect in prevention of impaired insulin metabolic signaling, type 2 diabetes, and cardiometabolic disorders. This review highlights findings from the recent surge in research regarding MR-related cardiometabolic disorders as well as our contemporary understanding of the detrimental effects of excess MR activation on insulin metabolic signaling.
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Affiliation(s)
- Guanghong Jia
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri.,Research Service, Truman Memorial Veterans Hospital, Columbia, Missouri
| | - Warren Lockette
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.,Department of Medicine and Physiology, Wayne State University, Detroit, Michigan
| | - James R Sowers
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.,Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
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11
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Olaniyi KS, Oniyide AA, Adeyanju OA, Ojulari LS, Omoaghe AO, Olaiya OE. Low dose spironolactone-mediated androgen-adiponectin modulation alleviates endocrine-metabolic disturbances in letrozole-induced PCOS. Toxicol Appl Pharmacol 2021; 411:115381. [PMID: 33359182 DOI: 10.1016/j.taap.2020.115381] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 12/11/2022]
Abstract
Polycystic ovarian syndrome (PCOS), is a multifactorial endocrine disorder in women of reproductive age. It usually associates with metabolic disorders (MDs), which aggravates the risk of infertility, cardiometabolic events and associated comorbidities in women with PCOS. Adiponectin, a circulating protein produced by adipocytes, which has been suggested to inversely correlate with MDs. Spironolactone, a non-selective mineralocorticoid receptor (MR) antagonist, has been in wide clinical use for several decades. Herein, we investigated the effects of low dose spironolactone (LDS) and the role of adiponectin in endocrine-metabolic disturbances in experimentally-induced PCOS rats. Eighteen female Wistar rats (160-180 g) were randomly allotted into 3 groups and treated with vehicle (p.o.), letrozole (LET; 1 mg/kg) and LET + LDS (0.25 mg/kg), once daily for 21 days, respectively. The results showed that LET-treated animals had features of PCOS, characterized by elevated plasma testosterone and prolactin, increased body weight gain and ovarian weight as well as disrupted ovarian cytoarchitecture and degenerated follicles. Additionally, elevated fasting blood glucose, 1 h-postload glucose and plasma insulin, impaired glucose tolerance, insulin resistance, reduced insulin sensitivity, increased plasma and ovarian lipid profile, plasma lipid peroxidation, TNF-α, IL-6 and decreased plasma glutathione peroxidase and glutathione content were observed. These alterations were associated with decreased circulating adiponectin and were reversed when treated with LDS. The present results suggest that LDS ameliorates endocrine-metabolic disturbances and inflammation-related comorbidities associated with LET-induced PCOS by modulating circulating androgen-adiponectin status.
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Affiliation(s)
- Kehinde S Olaniyi
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria.
| | - Adesola A Oniyide
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria
| | - Oluwaseun A Adeyanju
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria.
| | - Lekan S Ojulari
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria
| | - Adams O Omoaghe
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria
| | - Oluranti E Olaiya
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria
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12
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Adeyanju OA, Michael OS, Soladoye AO, Olatunji LA. Blockade of mineralocorticoid receptor ameliorates oral contraceptive-induced insulin resistance by suppressing elevated uric acid and glycogen synthase kinase-3 instead of circulating mineralocorticoid. Arch Physiol Biochem 2020; 126:225-234. [PMID: 30318954 DOI: 10.1080/13813455.2018.1509220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Context: Estrogen-progestin combined oral contraceptive (COC) has been connected to mineralocorticoid receptor (MR) activation and adverse cardiometabolic events. We consequently hypothesised that insulin resistance (IR), hyperuricemia, and elevated circulating GSK-3 induced by COC is through activation of MR via mineralocorticoid and glucocorticoid pathways.Methods: Female Wistar rats aged 12 weeks received (po) vehicle and COC (1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel) with or without MR blocker (0.25 mg/kg spironolactone; Spl), daily for eight weeks.Results: Data showed that COC treatment led to increased IR, 1-hour postload glucose level, insulinemia, triglyceride/HDL-cholesterol ratio, total cholesterol/HDL-cholesterol ratio, uric acid, GSK-3, aldosterone, corticosterone values, impaired glucose tolerance and pancreatic β-cell function. However, MR blockade by Spl ameliorated all these alterations except that of aldosterone.Conclusion: The results demonstrate that COC induces IR, hyperuricemia and high GSK-3 levels through activation of MR via glucocorticoid dependent pathway.
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Affiliation(s)
- O A Adeyanju
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, College of Medicine and Health sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - O S Michael
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, College of Health sciences, Bowen University, Iwo, Nigeria
| | - A O Soladoye
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, College of Health sciences, Bowen University, Iwo, Nigeria
| | - L A Olatunji
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
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13
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The Effects of Salt and Glucose Intake on Angiotensin II and Aldosterone in Obese and Nonobese Patients with Essential Hypertension. Int J Hypertens 2020; 2020:6017105. [PMID: 32257423 PMCID: PMC7106922 DOI: 10.1155/2020/6017105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/01/2020] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background The exact mechanisms for the development of essential hypertension are not known. Activation of the renin-angiotensin-aldosterone system (RAAS) in adipose tissue may represent an important link between obesity and hypertension. This study investigates the effects of oral intake of glucose with and without NaCl on angiotensin II (AngII) and aldosterone in obese and nonobese patients with essential hypertension. Methods Twenty newly diagnosed untreated essential hypertensive patients and 15 normotensive control subjects matched for age, gender, and BMI were studied. Participants fasted overnight (8–10 hrs), and then each subject took 75 gm glucose alone and with 3 gm NaCl, each dissolved in 250 ml. Subjects were monitored for 2 hours. Half hourly BP, plasma glucose (PG), serum Na+, K+, insulin, AngII, and aldosterone were measured. Subjects were classified into obese (BMI >30 Kg/m2) (11 patients and 8 control) and nonobese (BMI <30 Kg/m2) (9 patients and 7 control). Results After intake of glucose with NaCl serum, AngII was significantly higher in obese hypertensive patients compared with nonobese patients (P = 0.016). Intake of glucose with NaCl resulted in a significantly higher serum Na in obese hypertensive patients compared with nonobese patients Na (P = 0.009). Serum aldosterone was significantly higher in obese patients (P = 0.03, after glucose; P = 0.003, after glucose with NaCl) and in nonobese patients (P = 0.000 and P = 0.000, respectively) compared with their respective normotensive control subjects. In obese and nonobese patients, intake of glucose and glucose with NaCl showed no significant change in the levels of serum AngII and aldosterone which was associated a significant increase in serum Na in obese patients (P = 0.03) and a highly significant reduction in serum K in nonobese patients (P = 0.001). Conclusion Failure of suppression or inappropriate maintenance of secretion of AngII and aldosterone in both hypertensive groups by intake of glucose with NaCl may indicate a possible mechanism of essential hypertension.
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Kutsche HS, Schreckenberg R, Weber M, Hirschhäuser C, Rohrbach S, Li L, Niemann B, Schulz R, Schlüter KD. Alterations in Glucose Metabolism During the Transition to Heart Failure: The Contribution of UCP-2. Cells 2020; 9:cells9030552. [PMID: 32120777 PMCID: PMC7140436 DOI: 10.3390/cells9030552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
The cardiac expression of the mitochondrial uncoupling protein (UCP)-2 is increased in patients with heart failure. However, the underlying causes as well as the possible consequences of these alterations during the transition from hypertrophy to heart failure are still unclear. To investigate the role of UCP-2 mechanistically, expression of UCP-2 was silenced by small interfering RNA in adult rat ventricular cardiomyocytes. We demonstrate that a downregulation of UCP-2 by siRNA in cardiomyocytes preserves contractile function in the presence of angiotensin II. Furthermore, silencing of UCP-2 was associated with an upregulation of glucose transporter type (Glut)-4, increased glucose uptake, and reduced intracellular lactate levels, indicating improvement of the oxidative glucose metabolism. To study this adaptation in vivo, spontaneously hypertensive rats served as a model for cardiac hypertrophy due to pressure overload. During compensatory hypertrophy, we found low UCP-2 levels with an upregulation of Glut-4, while the decompensatory state with impaired function was associated with an increase of UCP-2 and reduced Glut-4 expression. By blocking the aldosterone receptor with spironolactone, both cardiac function as well as UCP-2 and Glut-4 expression levels of the compensated phase could be preserved. Furthermore, we were able to confirm this by left ventricular (LV) biopsies of patients with end-stage heart failure. The results of this study show that UCP-2 seems to impact the cardiac glucose metabolism during the transition from hypertrophy to failure by affecting glucose uptake through Glut-4. We suggest that the failing heart could benefit from low UCP-2 levels by improving the efficiency of glucose oxidation. For this reason, UCP-2 inhibition might be a promising therapeutic strategy to prevent the development of heart failure.
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Affiliation(s)
- Hanna Sarah Kutsche
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
- Correspondence: ; Tel.: +49-641-99-47145
| | - Rolf Schreckenberg
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
| | - Martin Weber
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
| | - Christine Hirschhäuser
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
| | - Susanne Rohrbach
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
| | - Ling Li
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
| | - Bernd Niemann
- Universitätsklinikum Gießen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie, 35392 Gießen, Germany;
| | - Rainer Schulz
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
| | - Klaus-Dieter Schlüter
- Physiologisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany; (R.S.); (M.W.); (C.H.); (S.R.); (L.L.); (R.S.); (K.-D.S.)
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15
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Adeyanju OA, Falodun TO, Fabunmi OA, Olatunji LA, Soladoye AO. Very low dose spironolactone protects experimentally-induced polycystic ovarian syndrome from insulin-resistant metabolic disturbances by suppressing elevated circulating testosterone. Chem Biol Interact 2019; 310:108742. [PMID: 31295448 DOI: 10.1016/j.cbi.2019.108742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age and hyperandrogenism is a prominent feature of PCOS resulting in infertility and increased risk of developing metabolic disorders including insulin resistance (IR), abdominal adiposity, glucose intolerance and cardiovascular diseases. Spironolactone (SPL), a non-selective mineralocorticoid receptor (MR) antagonist, has been in wide clinical use for several decades. In this study, we investigated the effects of SPL on IR and metabolic disturbances in letrozole-induced PCOS rats. Eighteen adults female Wistar rats were randomly divided into 3 groups and treated with vehicle, letrozole (LET; 1 mg/kg) and LET + SPL (SPL; 0.25 mg/kg), p.o. once daily for 21 consecutive days. Results showed that LET treatment induced PCOS characterised by elevated plasma testosterone and luteinizing hormone (LH) accompanied with increased body weight and visceral adiposity, IR, glucose intolerance, dyslipidemia and altered histomorphological ovaries. Treatment with SPL however attenuated the elevated testosterone in LET-induced PCOS model accompanied with a reversal in all the observed alterations. Taken together, analysis of the physical, biochemical and histological evidences shows that the protective effect of this very low dose spironolactone may be through its anti-androgenic mechanism.
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Affiliation(s)
- Oluwaseun A Adeyanju
- Cardiometabolic Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria; HOPE Cardiometabolic Research Team & Department of Physiology, University of Ilorin, Ilorin, Nigeria.
| | - Timothy O Falodun
- Cardiometabolic Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | | | - Lawrence A Olatunji
- HOPE Cardiometabolic Research Team & Department of Physiology, University of Ilorin, Ilorin, Nigeria
| | - Ayodele O Soladoye
- Cardiometabolic Research Unit, Department of Physiology, College of Health and Medical Sciences, Bowen University, Iwo, Nigeria
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Wang J, Hu H, Song J, Yan F, Qin J, Guo X, Cui C, He Q, Hou X, Liu F, Chen L. Aldosterone induced up-expression of ICAM-1 and ET-1 in pancreatic islet endothelium may associate with progression of T2D. Biochem Biophys Res Commun 2019; 512:750-757. [DOI: 10.1016/j.bbrc.2019.03.149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/22/2019] [Indexed: 01/01/2023]
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Bothou C, Beuschlein F, Spyroglou A. Links between aldosterone excess and metabolic complications: A comprehensive review. DIABETES & METABOLISM 2019; 46:1-7. [PMID: 30825519 DOI: 10.1016/j.diabet.2019.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
Shortly after the first description of primary aldosteronism (PA) appeared in the 1950s by Jerome Conn, an association of the condition with diabetes mellitus was documented. However, a clear pathophysiological interrelationship linking the two entities has yet to be established. Nevertheless, so far, many mechanisms contributing to insulin resistance and dysregulation of glucose uptake have been described. At the same time, many observational studies have reported an increased prevalence of the metabolic syndrome (MetS) among patients with PA. Regarding the relationship between aldosterone levels and obesity, a vicious cycle of adipokine-induced aldosterone production and aldosterone adipogenic action may be further contributing to MetS manifestations in PA patients. However, whether aldosterone excess affects lipid metabolism is still under investigation. Also, recent findings of the coexistence of glucocorticoid excess in many cases of PA highlight the need for further studies to examine the presumed link between high aldosterone levels and various metabolic parameters. In the present review, our focus is to comprehensively present the spectrum of available research findings concerning the possible associations between aldosterone excess and metabolic alterations, including impaired glucose metabolism, insulin resistance and, consequently, diabetes, altered lipid metabolism and the development of fatty liver. In addition, the complex relationship between obesity and aldosterone is discussed in detail.
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Affiliation(s)
- C Bothou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland; Competence Centre of Personalized Medicine, Molecular and Translational Biomedicine PhD Program, University of Zurich, Zurich, Switzerland
| | - F Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU, Munich, Germany.
| | - A Spyroglou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
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Kwak MK, Lee SE, Cho YY, Suh S, Kim BJ, Song KH, Koh JM, Kim JH, Lee SH. The Differential Effect of Excess Aldosterone on Skeletal Muscle Mass by Sex. Front Endocrinol (Lausanne) 2019; 10:195. [PMID: 30984113 PMCID: PMC6450066 DOI: 10.3389/fendo.2019.00195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/07/2019] [Indexed: 01/04/2023] Open
Abstract
The effects of excess aldosterone on skeletal muscle in individuals with primary aldosteronism (PA) are unknown. To examine the effects of aldosterone on skeletal muscle mass in patients with PA, by sex, 309 consecutive patients were enrolled. Skeletal muscle and fat mass of 62 patients with PA were compared with those of 247 controls with non-functioning adrenal incidentaloma (NFAI). Body composition parameters were measured using bioelectrical impedance analysis, and plasma aldosterone concentration (PAC) was measured using radioimmunoassay. The PAC in all women, but not in men, showed an inverse association with both appendicular skeletal muscle mass (ASM) (β = -0.197, P = 0.016) and height-adjusted ASM (HA-ASM) (β = -0.207, P = 0.009). HA-ASM in women (but not in men) with PA was 5.0% lower than that in women with NFAI (P = 0.036). Furthermore, women with PA had a lower HA-ASM than 1:1 age- and sex-matched controls with NFAI by 5.7% (P = 0.049) and tended to have a lower HA-ASM than 1:3 age-, sex-, and menopausal status-matched controls without adrenal incidentaloma (AI) by 7.3% (P = 0.053). The odds ratio (OR), per quartile increase in PAC, of low HA-ASM in women was 1.18 [95% confidence interval (CI), 1.01-1.39; P = 0.035]. The odds of HA-ASM in subjects with PA were 10.63-fold (95% CI: 0.83-135.50) higher, with marginal significance (P = 0.069) than in those with NFAI. Skeletal muscle mass in women with PA was lower than that in women with NFAI; suggesting that excess aldosterone has adverse effects on skeletal muscle metabolism.
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Affiliation(s)
- Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dontan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, South Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Jae Hyeon Kim
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Seung Hun Lee
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Park S. Emerging Role of Aldosterone in Mediating the Vicious Cycle of Obesity, Insulin Resistance and Metabolic Syndrome. Korean Circ J 2018; 48:227-229. [PMID: 29557109 PMCID: PMC5861315 DOI: 10.4070/kcj.2018.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/18/2018] [Accepted: 03/02/2018] [Indexed: 01/31/2023] Open
Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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20
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Olatunji LA, Usman TO, Akinade AI, Adeyanju OA, Kim I, Soladoye AO. Low-dose spironolactone ameliorates insulin resistance and suppresses elevated plasminogen activator inhibitor-1 during gestational testosterone exposure. Arch Physiol Biochem 2017; 123:286-292. [PMID: 28480754 DOI: 10.1080/13813455.2017.1320681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Elevated gestational circulating testosterone has been associated with pathological pregnancies that increase the risk of development of cardiometabolic disorder in later life. OBJECTIVE We hypothesised that gestational testosterone exposure, in late pregnancy, causes glucose deregulation and atherogenic dyslipidaemia that would be accompanied by high plasminogen activator inhibitor-1 (PAI-1). The study also hypothesise that low-dose spironolactone treatment would ameliorate these effects. METHODS Pregnant Wistar rats received vehicle, testosterone (0.5 mg/kg; sc), spironolactone (0.5 mg/kg, po) or testosterone and spironolactone daily between gestational days 15 and 19. RESULTS Gestational testosterone exposure led to increased HOMA-IR, circulating insulin, testosterone, 1-h post-load glucose, atherogenic dyslipidaemia, PLR, PAI-1 and MDA. However, all these effects, except that of circulating testosterone, were ameliorated by spironolactone. CONCLUSIONS These results demonstrate that low-dose spironolactone ameliorates glucose deregulation and atherogenic dyslipidaemia during elevated gestational testosterone exposure, at least in part, by suppressing elevated PAI-1.
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Affiliation(s)
- Lawrence A Olatunji
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
| | - Taofeek O Usman
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
- b Department of Physiology, Cardiovascular Unit, College of Health sciences , Osun State University , Osogbo , Nigeria
| | - Aminat I Akinade
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
| | - Oluwaseun A Adeyanju
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
| | - InKyeom Kim
- c Department of Pharmacology, Cardiovascular Research Institute , Kyungpook National University School of Medicine , Daegu , Republic of Korea
| | - Ayodele O Soladoye
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
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Yan B, Sun Y, Wang J. Depletion of ubiA prenyltransferase domain containing 1 expression promotes angiotensin II‑induced hypertrophic response in AC16 human myocardial cells via modulating the expression levels of coenzyme Q10 and endothelial nitric oxide synthase. Mol Med Rep 2017; 16:6910-6915. [PMID: 28901410 DOI: 10.3892/mmr.2017.7407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/22/2017] [Indexed: 11/06/2022] Open
Abstract
UbiA prenyltransferase domain containing 1 (UBIAD1) is closely associated with cardiovascular diseases. However, at the cellular level, little is known about how UBIAD1 is expressed and functions in cardiomyocyte hypertrophy. The aim of the present study was to investigate the expression and role of UBIAD1 in angiotensin II (Ang II)‑induced hypertrophy in AC16 cardiomyoblast cells. The loss‑of‑function approach was used to knock down UBIAD1 in vehicle‑ and Ang II‑stimulated AC16 cells. The levels of atrial natriuretic factor (ANF) and caspase-3 were measured and compared between vehicle‑ and Ang II‑treated AC16 cells pretreated with control siRNA or siRNA against UBIAD1. In addition, the levels of coenzyme Q10 (CoQ10) and endothelial nitric oxide synthase (eNOS) were evaluated and compared between these groups. Ang II induced hypertrophy and apoptosis in AC16 cells, accompanied by increased expression of ANF and caspase-3, and decreased expression of UBIAD1. These effects were potentiated by UBIAD1 knockdown. In addition, Ang II treatment suppressed the expression of CoQ10 and eNOS, as well as the production of NO, and these inhibitory effects were also enhanced by UBIAD1 knockdown. Thus, silencing of UBIAD1 expression promotes a myocardial hypertrophic response to Ang II stimulation, in part, by suppressing the expression of CoQ10 and eNOS.
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Affiliation(s)
- Bingju Yan
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Jun Wang
- Department of Cardiology General Surgery, First Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
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22
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Infante M, Armani A, Mammi C, Fabbri A, Caprio M. Impact of Adrenal Steroids on Regulation of Adipose Tissue. Compr Physiol 2017; 7:1425-1447. [PMID: 28915330 DOI: 10.1002/cphy.c160037] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Corticosteroids are secreted by the adrenal glands and control the functions of adipose tissue via the activation of mineralocorticoid receptor (MR) and glucocorticoid receptor (GR). In turn, adipocytes release a large variety of adipokines into the bloodstream, regulating the function of several organs and tissues, including the adrenal glands, hereby controlling corticosteroid production. In adipose tissue, the activation of the MR by glucocorticoids (GC) and aldosterone affects important processes such as adipocyte differentiation, oxidative stress, autophagic flux, adipokine expression as well as local production of GC through upregulation of the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Notably, the proinflammatory responses induced by the MR are counteracted by activation of the GR, whose activity inhibits the expression of inflammatory adipokines. Both GR and MR are deeply involved in adipogenesis and adipose expansion; hence pharmacological blockade of these two receptors has proven effective against adipose tissue dysfunction in experimental models of obesity and metabolic syndrome (MetS), suggesting a potential use for MR and GR antagonists in these clinical settings. Importantly, obesity and Cushing's syndrome (CS) share metabolic similarities and are characterized by high levels of circulating corticosteroids, which in turn are able to deeply affect adipose tissue. In addition, pharmacological approaches aimed at reducing aldosterone and GC levels, by means of the inhibition of CYP11B2 (aldosterone synthase) or 11β-HSD1, represent alternative strategies to counter the detrimental effects of excessive levels of corticosteroids, which are often observed in obesity and, more general, in MetS. © 2017 American Physiological Society. Compr Physiol 7:1425-1447, 2017.
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Affiliation(s)
- Marco Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University Tor Vergata, Rome, Italy
| | - Andrea Armani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Caterina Mammi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Andrea Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University Tor Vergata, Rome, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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23
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Hofmann A, Brunssen C, Peitzsch M, Martin M, Mittag J, Jannasch A, Engelmann F, Brown NF, Weldon SM, Huber J, Streicher R, Deussen A, Eisenhofer G, Bornstein SR, Morawietz H. Aldosterone Synthase Inhibition Improves Glucose Tolerance in Zucker Diabetic Fatty (ZDF) Rats. Endocrinology 2016; 157:3844-3855. [PMID: 27526033 DOI: 10.1210/en.2016-1358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Plasma aldosterone is elevated in type 2 diabetes and obesity in experimental and clinical studies and can act to inhibit both glucose-stimulated insulin secretion by the β-cell and insulin signaling. Currently mineralocorticoid receptor antagonism is the best characterized treatment to ameliorate aldosterone-mediated effects. A second alternative is inhibition of aldosterone synthase, an approach with protective effects on end-organ damage in heart or kidney in animal models. The effect of aldosterone synthase inhibition on metabolic parameters in type 2 diabetes is not known. Therefore, male Zucker diabetic fatty (ZDF) rats were treated for 11 weeks with the aldosterone synthase inhibitor FAD286, beginning at 7 weeks of age. Results were compared with the mineralocorticoid receptor antagonist eplerenone. Plasma aldosterone was abolished by FAD286 and elevated more than 9-fold by eplerenone. The area under the curve calculated from an oral glucose tolerance test (OGTT) was lower and overall insulin response during OGTT was increased by FAD286. In contrast, eplerenone elevated blood glucose levels and blunted insulin secretion during the OGTT. Fasting glucose was lowered and fasting insulin was increased by FAD286 in the prediabetic state. Glycated hemoglobin was lowered by FAD286, whereas eplerenone showed no effect. We conclude that aldosterone synthase inhibition, in contrast to mineralocorticoid receptor antagonism, has the potential for beneficial effects on metabolic parameters in type 2 diabetes.
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Affiliation(s)
- Anja Hofmann
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Coy Brunssen
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Mirko Peitzsch
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Melanie Martin
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Jennifer Mittag
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Anett Jannasch
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Felix Engelmann
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Nicholas F Brown
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Steven M Weldon
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Jochen Huber
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Rüdiger Streicher
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Andreas Deussen
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Graeme Eisenhofer
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Stefan R Bornstein
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation (A.H., C.B., J.M., F.E., H.M.) and Division of Clinical Neurochemistry (M.P., G.E.), Institute of Clinical Chemistry and Laboratory Medicine, Department of Medicine III (G.E., S.R.B.), University Hospital Carl Gustav Carus Dresden, and Institute of Physiology (M.M., A.D.) and Department of Cardiac Surgery (A.J.), Herzzentrum Dresden, Medical Faculty, Technische Universität Dresden, 01307 Dresden, Germany; Department of Cardio Metabolic Diseases (N.F.B., S.M.W.), Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut 06877; Department of Cardio Metabolic Diseases (J.H., R.S.), Boehringer Ingelheim Pharma GmbH and Co KG, 88400 Biberach, Germany; and Department of Endocrinology and Diabetes (S.R.B.), Division of Diabetes and Nutritional Sciences, Rayne Institute, Faculty of Life Sciences and Medicine, Kings College London, London, SE5 9PJ, United Kingdom
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Ramalingam L, Menikdiwela K, LeMieux M, Dufour JM, Kaur G, Kalupahana N, Moustaid-Moussa N. The renin angiotensin system, oxidative stress and mitochondrial function in obesity and insulin resistance. Biochim Biophys Acta Mol Basis Dis 2016; 1863:1106-1114. [PMID: 27497523 DOI: 10.1016/j.bbadis.2016.07.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/25/2016] [Indexed: 12/13/2022]
Abstract
Obesity is a complex disease characterized by excessive expansion of adipose tissue and is an important risk factor for chronic diseases such as cardiovascular disorders, hypertension and type 2 diabetes. Moreover, obesity is a major contributor to inflammation and oxidative stress, all of which are key underlying causes for diabetes and insulin resistance. Specifically, adipose tissue secretes bioactives molecules such as inflammatory hormone angiotensin II, generated in the Renin Angiotensin System (RAS) from its precursor angiotensinogen. Accumulated evidence suggests that RAS may serve as a strong link between obesity and insulin resistance. Dysregulation of RAS also occurs in several other tissues including those involved in regulation of glucose and whole body homeostasis as well as insulin sensitivity such as muscle, liver and pancreas and heart. Here we review the scientific evidence for these interactions and potential roles for oxidative stress, inflammation and mitochondrial dysfunction in these target tissues which may mediate effects of RAS in metabolic diseases. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy.
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Affiliation(s)
- Latha Ramalingam
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States; Obesity Research Cluster, Texas Tech University, Lubbock, TX, United States
| | - Kalhara Menikdiwela
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Monique LeMieux
- Department of Nutrition and Food Sciences, Texas Women's University, Denton, TX, United States
| | - Jannette M Dufour
- Obesity Research Cluster, Texas Tech University, Lubbock, TX, United States; Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Gurvinder Kaur
- Obesity Research Cluster, Texas Tech University, Lubbock, TX, United States; Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Nishan Kalupahana
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States; Obesity Research Cluster, Texas Tech University, Lubbock, TX, United States; Department of Physiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States; Obesity Research Cluster, Texas Tech University, Lubbock, TX, United States.
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25
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Chadwick JA, Hauck JS, Lowe J, Shaw JJ, Guttridge DC, Gomez-Sanchez CE, Gomez-Sanchez EP, Rafael-Fortney JA. Mineralocorticoid receptors are present in skeletal muscle and represent a potential therapeutic target. FASEB J 2015; 29:4544-54. [PMID: 26178166 DOI: 10.1096/fj.15-276782] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Early treatment with heart failure drugs lisinopril and spironolactone improves skeletal muscle pathology in Duchenne muscular dystrophy (DMD) mouse models. The angiotensin converting enzyme inhibitor lisinopril and mineralocorticoid receptor (MR) antagonist spironolactone indirectly and directly target MR. The presence and function of MR in skeletal muscle have not been explored. MR mRNA and protein are present in all tested skeletal muscles from both wild-type mice and DMD mouse models. MR expression is cell autonomous in both undifferentiated myoblasts and differentiated myotubes from mouse and human skeletal muscle cultures. To test for MR function in skeletal muscle, global gene expression analysis was conducted on human myotubes treated with MR agonist (aldosterone; EC50 1.3 nM) or antagonist (spironolactone; IC50 1.6 nM), and 53 gene expression differences were identified. Five differences were conserved in quadriceps muscles from dystrophic mice treated with spironolactone plus lisinopril (IC50 0.1 nM) compared with untreated controls. Genes down-regulated more than 2-fold by MR antagonism included FOS, ANKRD1, and GADD45B, with known roles in skeletal muscle, in addition to NPR3 and SERPINA3, bona fide targets of MR in other tissues. MR is a novel drug target in skeletal muscle and use of clinically safe antagonists may be beneficial for muscle diseases.
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Affiliation(s)
- Jessica A Chadwick
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J Spencer Hauck
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jeovanna Lowe
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jeremiah J Shaw
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Denis C Guttridge
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Celso E Gomez-Sanchez
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elise P Gomez-Sanchez
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jill A Rafael-Fortney
- *Department of Molecular and Cellular Biochemistry, Department of Physiology and Cell Biology, Department of Molecular Virology, Immunology, and Medical Genetics College of Medicine, The Ohio State University, Columbus, Ohio, USA; and Department of Internal Medicine and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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26
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Chou CL, Pang CY, Lee TJF, Fang TC. Beneficial effects of calcitriol on hypertension, glucose intolerance, impairment of endothelium-dependent vascular relaxation, and visceral adiposity in fructose-fed hypertensive rats. PLoS One 2015; 10:e0119843. [PMID: 25774877 PMCID: PMC4361671 DOI: 10.1371/journal.pone.0119843] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 02/03/2015] [Indexed: 01/23/2023] Open
Abstract
Besides regulating calcium homeostasis, the effects of vitamin D on vascular tone and metabolic disturbances remain scarce in the literature despite an increase intake with high-fructose corn syrup worldwide. We investigated the effects of calcitriol, an active form of vitamin D, on vascular relaxation, glucose tolerance, and visceral fat pads in fructose-fed rats. Male Wistar-Kyoto rats were divided into 4 groups (n = 6 per group). Group Con: standard chow diet for 8 weeks; Group Fru: high-fructose diet (60% fructose) for 8 weeks; Group Fru-HVD: high-fructose diet as Group Fru, high-dose calcitriol treatment (20 ng / 100 g body weight per day) 4 weeks after the beginning of fructose feeding; and Group Fru-LVD: high-fructose diet as Group Fru, low-dose calcitriol treatment (10 ng / 100 g body weight per day) 4 weeks after the beginning of fructose feeding. Systolic blood pressure was measured twice a week by the tail-cuff method. Blood was examined for serum ionized calcium, phosphate, creatinine, glucose, triglycerides, and total cholesterol. Intra-peritoneal glucose intolerance test, aortic vascular reactivity, the weight of visceral fat pads, adipose size, and adipose angiotensin II levels were analyzed at the end of the study. The results showed that the fructose-fed rats significantly developed hypertension, impaired glucose tolerance, heavier weight and larger adipose size of visceral fat pads, and raised adipose angiotensin II expressions compared with the control rats. High- and low-dose calcitriol reduced modestly systolic blood pressure, increased endothelium-dependent aortic relaxation, ameliorated glucose intolerance, reduced the weight and adipose size of visceral fat pads, and lowered adipose angiotensin II expressions in the fructose-fed rats. However, high-dose calcitriol treatment mildly increased serum ionized calcium levels (1.44 ± 0.05 mmol/L). These results suggest a protective role of calcitriol treatment on endothelial function, glucose tolerance, and visceral adiposity in fructose-fed rats.
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Affiliation(s)
- Chu-Lin Chou
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Yoong Pang
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Tony J. F. Lee
- Institutes of Life Sciences, Pharmacology & Toxicology, and Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Te-Chao Fang
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Favre GA, Esnault VLM, Van Obberghen E. Modulation of glucose metabolism by the renin-angiotensin-aldosterone system. Am J Physiol Endocrinol Metab 2015; 308:E435-49. [PMID: 25564475 DOI: 10.1152/ajpendo.00391.2014] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The renin-angiotensin-aldosterone system (RAAS) is an enzymatic cascade functioning in a paracrine and autocrine fashion. In animals and humans, RAAS intrinsic to tissues modulates food intake, metabolic rate, adiposity, insulin sensitivity, and insulin secretion. A large array of observations shows that dysregulation of RAAS in the metabolic syndrome favors type 2 diabetes. Remarkably, angiotensin-converting enzyme inhibitors, suppressing the synthesis of angiotensin II (ANG II), and angiotensin receptor blockers, targeting the ANG II type 1 receptor, prevent diabetes in patients with hypertensive or ischemic cardiopathy. These drugs interrupt the negative feedback loop of ANG II on the RAAS cascade, which results in increased production of angiotensins. In addition, they change the tissue expression of RAAS components. Therefore, the concept of a dual axis of RAAS regarding glucose homeostasis has emerged. The RAAS deleterious axis increases the production of inflammatory cytokines and raises oxidative stress, exacerbating the insulin resistance and decreasing insulin secretion. The beneficial axis promotes adipogenesis, blocks the production of inflammatory cytokines, and lowers oxidative stress, thereby improving insulin sensitivity and secretion. Currently, drugs targeting RAAS are not given for the purpose of preventing diabetes in humans. However, we anticipate that in the near future the discovery of novel means to modulate the RAAS beneficial axis will result in a decisive therapeutic breakthrough.
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Affiliation(s)
- Guillaume A Favre
- Institut National de la Sante et de la Recherche Medicale, U 1081, Institute for Research on Cancer and Aging of Nice (IRCAN), "Aging and Diabetes" Team, Nice, France; Centre National de la Recherche Scientifique, UMR7284, IRCAN, Nice, France; University of Nice-Sophia Antipolis, Nice, France; Nephrology Department, University Hospital, Nice, France; and
| | - Vincent L M Esnault
- Institut National de la Sante et de la Recherche Medicale, U 1081, Institute for Research on Cancer and Aging of Nice (IRCAN), "Aging and Diabetes" Team, Nice, France; Centre National de la Recherche Scientifique, UMR7284, IRCAN, Nice, France; University of Nice-Sophia Antipolis, Nice, France; Nephrology Department, University Hospital, Nice, France; and
| | - Emmanuel Van Obberghen
- Institut National de la Sante et de la Recherche Medicale, U 1081, Institute for Research on Cancer and Aging of Nice (IRCAN), "Aging and Diabetes" Team, Nice, France; Centre National de la Recherche Scientifique, UMR7284, IRCAN, Nice, France; University of Nice-Sophia Antipolis, Nice, France; Clinical Chemistry Laboratory, University Hospital, Nice, France
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Franklin M, Hlavacova N, Babic S, Pokusa M, Bermudez I, Jezova D. Aldosterone Signals the Onset of Depressive Behaviour in a Female Rat Model of Depression along with SSRI Treatment Resistance. Neuroendocrinology 2015; 102:274-287. [PMID: 25968351 DOI: 10.1159/000431152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/02/2015] [Indexed: 11/19/2022]
Abstract
Depression is a serious condition that occurs more frequently in women and is often associated with treatment resistance. The main hypotheses of this study are that (a) aldosterone is an early marker of depression onset and (b) a tryptophan (TRP) depletion model of depression previously validated in male rats is treatment resistant in females. To explore possible underlying mechanisms, we have focused on factors shown to be altered in patients with treatment-resistant depression. Female Sprague-Dawley rats were treated with a control or low-TRP-containing diet for various time periods up to 21 days. The results show that aldosterone secretion increased after 4 days of TRP depletion and prior to corticosterone. Optimal effects of TRP depletion occurred at 14 days. In addition to neurochemical and behavioural changes observed previously in males, TRP depletion in females was associated with a significant decline in serum magnesium concentrations, increased serum interleukin-6, enhanced gene expression of orexin A in the frontal cortex and induced a rise in N-methyl-D-aspartate (NMDA) receptor Bmax in the amygdala. Depression-like behaviour, NMDA receptor upregulation, enhancement of the kynurenine-to-kynurenic acid ratio and magnesium were resistant to paroxetine treatment (10 mg/kg/day in drinking water for 14 days). In conclusion, aldosterone may represent an important early marker for the onset of depression-like behaviour. With respect to treatment resistance, the underlying mechanisms may involve pro-inflammatory cytokines, the kynurenine pathway, magnesium, glutamate neurotransmission and the orexin pathway. This model of treatment-resistant depression may be useful for the future development of new compounds with novel antidepressant properties.
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Luther JM. Effects of aldosterone on insulin sensitivity and secretion. Steroids 2014; 91:54-60. [PMID: 25194457 PMCID: PMC4252580 DOI: 10.1016/j.steroids.2014.08.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/25/2014] [Accepted: 08/17/2014] [Indexed: 12/19/2022]
Abstract
Dr. Conn originally reported an increased risk of diabetes in patients with hyperaldosteronism in the 1950s, although the mechanism remains unclear. Aldosterone-induced hypokalemia was initially described to impair glucose tolerance by impairing insulin secretion. Correction of hypokalemia by potassium supplementation only partially restored insulin secretion and glucose tolerance, however. Aldosterone also impairs glucose-stimulated insulin secretion in isolated pancreatic islets via reactive oxygen species in a mineralocorticoid receptor-independent manner. Aldosterone-induced mineralocorticoid receptor activation also impairs insulin sensitivity in adipocytes and skeletal muscle. Aldosterone may produce insulin resistance secondarily by altering potassium, increasing inflammatory cytokines, and reducing beneficial adipokines such as adiponectin. Renin-angiotensin system antagonists reduce circulating aldosterone concentrations and also the risk of type 2 diabetes in clinical trials. These data suggest that primary and secondary hyperaldosteronism may contribute to worsening glucose tolerance by impairing insulin sensitivity or insulin secretion in humans. Future studies should define the effects of MR antagonists and aldosterone on insulin secretion and sensitivity in humans.
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Affiliation(s)
- James M Luther
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, United States.
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Meinel S, Gekle M, Grossmann C. Mineralocorticoid receptor signaling: crosstalk with membrane receptors and other modulators. Steroids 2014; 91:3-10. [PMID: 24928729 DOI: 10.1016/j.steroids.2014.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 05/16/2014] [Accepted: 05/28/2014] [Indexed: 12/30/2022]
Abstract
The mineralocorticoid receptor (MR) belongs to the steroid receptor superfamily. Classically, it acts as a ligand-bound transcription factor in epithelial tissues, where it regulates water and electrolyte homeostasis and controls blood pressure. Additionally, the MR has been shown to elicit pathophysiological effects including inflammation, fibrosis and remodeling processes in the cardiovascular system and the kidneys and MR antagonists have proven beneficial for patients with certain cardiovascular and renal disease. The underlying molecular mechanisms that mediate MR effects have not been fully elucidated but very likely rely on interactions with other signaling pathways in addition to genomic actions at hormone response elements. In this review we will focus on interactions of MR signaling with different membrane receptors, namely receptor tyrosine kinases and the angiotensin II receptor because of their potential relevance for disease. In addition, GPR30 is discussed as a new aldosterone receptor. To gain insights into the problem why the MR only seems to mediate pathophysiological effects in the presence of additional permissive factors we will also briefly discuss factors that lead to modulation of MR activity as well. Overall, MR signaling is part of an intricate network that still needs to be investigated further.
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Affiliation(s)
- S Meinel
- Julius Bernstein Institute of Physiology, Martin Luther University Halle-Wittenberg, Germany
| | - M Gekle
- Julius Bernstein Institute of Physiology, Martin Luther University Halle-Wittenberg, Germany
| | - C Grossmann
- Julius Bernstein Institute of Physiology, Martin Luther University Halle-Wittenberg, Germany.
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Plasma 8-isoprostane levels are associated with endothelial dysfunction in resistant hypertension. Clin Chim Acta 2014; 433:179-83. [PMID: 24657423 DOI: 10.1016/j.cca.2014.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired endothelial function and arterial stiffness are associated with hypertension and are important risk factors for cardiovascular events. Reactive oxygen species reduce nitric oxide bioavailability and have a pivotal role in endothelial function. Resistant hypertension (RHTN) is characterized by blood pressure (BP) above goal (140/90mmHg) in spite of the concurrent use of ≥3 antihypertensive drugs of different classes. This study evaluated the association between 8-isoprostane levels, an oxidative stress marker, endothelial function and arterial stiffness, in RHTN. METHODS Ninety-four RHTN and 55 well-controlled hypertensive (HT) patients were included. Plasma 8-isoprostane levels were determined by ELISA. Also, flow-mediated dilation (FMD) and pulse wave velocity (PWV) were evaluated to determine endothelial function and arterial stiffness, respectively. RESULTS Levels of 8-isoprostane were markedly higher in RHTN compared to HT patients (22.5±11.2 vs. 17.3±9.8pg/ml, p<0.05, respectively). A significant inverse correlation was observed between FMD and 8-isoprostane (r=-0.35, p=0.001) in RHTN. Finally, multiple logistic regression revealed that 8-isoprostane was a significant predictor of endothelial dysfunction (FMD≤median) in RHTN group. CONCLUSION RHTN showed markedly higher oxidative stress measured by 8-isoprostane, compared to HT patients. Taken together, our findings suggest the involvement of oxidative stress in endothelial function in RHTN.
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Lastra G, Syed S, Kurukulasuriya LR, Manrique C, Sowers JR. Type 2 diabetes mellitus and hypertension: an update. Endocrinol Metab Clin North Am 2014; 43:103-22. [PMID: 24582094 PMCID: PMC3942662 DOI: 10.1016/j.ecl.2013.09.005] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with hypertension and type 2 diabetes are at increased risk of cardiovascular and chronic renal disease. Factors involved in the pathogenesis of both hypertension and type 2 diabetes include inappropriate activation of the renin-angiotensin-aldosterone system, oxidative stress, inflammation, impaired insulin-mediated vasodilatation, augmented sympathetic nervous system activation, altered innate and adaptive immunity, and abnormal sodium processing by the kidney. The renin-angiotensin-aldosterone system blockade is a key therapeutic strategy in the treatment of hypertension in type 2 diabetes. Emerging therapies for resistant hypertension as often exists in patients with diabetes, include renal denervation and carotid body denervation.
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Affiliation(s)
- Guido Lastra
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA; Harry S Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201, USA
| | - Sofia Syed
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA
| | - L Romayne Kurukulasuriya
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA
| | - Camila Manrique
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA; Harry S Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201, USA
| | - James R Sowers
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Drive, Columbia, MO 65212, USA; Diabetes and Cardiovascular Research Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA; Harry S Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201, USA; Department of Medical Physiology and Pharmacology, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
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Long HD, Lin YE, Liu MJ, Liang LY, Zeng ZH. Spironolactone prevents dietary-induced metabolic syndrome by inhibiting PI3-K/Akt and p38MAPK signaling pathways. J Endocrinol Invest 2013; 36:923-30. [PMID: 23612445 DOI: 10.3275/8946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Aim of the study is to evaluate the impact of spironolactone (SPL) on indexes of metabolic syndrome (MS) and further investigate the mechanisms underlying its protective effects. METHODS A rat model of MS was established by administering a fat- and salt-enriched diet (FS diet). The occurrence of MS was examined by measurement of blood pressure (BP), aldosterone (ALD) content, blood lipid (BL), glucose and insulin levels. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Pancreatic gland tissue injury was assessed by β-cell apoptosis. Mineralocorticoid receptor (MR) activity, phosphatidylinositol 3- kinase/Akt (PI3-K/Akt), and phosphorylation of p38MAPK (Pp38MAPK) in pancreatic gland tissue were evaluated by western blot analysis. RESULTS SPL prevented hypertension, and dyslipidemia during MS induced by the intake of FS diet, but had no effect on K+ and Na+ disturbances. Furthermore, SPL significantly attenuated ALD and MR expression levels after FS diet. Finally, SPL inhibited phosphorylation protein kinase B (p- PKB) activation in the pancreatic gland tissue, a downstream target of PI3-K, and phosphorylation of p38MAPK pathway, critical for cellular apoptosis. CONCLUSIONS This study demonstrates that SPL exerts a protective effect on hypertension and dyslipidemia. This protective effect may depend, at least in part, on MAPK and PI3-K pathways.
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Affiliation(s)
- H D Long
- Department of Internal Medicine, Affiliated Tumor Hospital of Guangzhou Medical College, Guangzhou, Guangdong Province, China
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Sherajee SJ, Rafiq K, Nakano D, Mori H, Kobara H, Hitomi H, Fujisawa Y, Kobori H, Masaki T, Nishiyama A. Aldosterone aggravates glucose intolerance induced by high fructose. Eur J Pharmacol 2013; 720:63-8. [PMID: 24201309 DOI: 10.1016/j.ejphar.2013.10.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/21/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
We previously reported that aldosterone impaired vascular insulin signaling in vivo and in vitro. Fructose-enriched diet induces metabolic syndrome including hypertension, insulin resistance, hyperlipidemia and diabetes in animal. In the current study, we hypothesized that aldosterone aggravated fructose feeding-induced glucose intolerance in vivo. Rats were divided into five groups for six-week treatment; uninephrectomy (Unx, n=8), Unx+aldosterone (aldo, 0.75 µg/h, s.c., n=8), Unx+fructose (fruc, 10% in drinking water, n=8), Unx+aldo+fruc, (aldo+fruc, n=8), and Unx+aldo+fruc+spironolactone, a mineralocorticoid receptor antagonist (aldo+fruc+spiro, 20mg/kg/day, p.o., n=8). Aldo+fruc rats manifested the hypertension, and induced glucose intolerance compared to fruc intake rats assessed by oral glucose tolerance test, homeostasis model assessment of insulin resistance and hyperinsulinemic-euglycemic clamp study. Spironolactone, significantly improved the aldosterone-accelerated glucose intolerance. Along with improvement in insulin resistance, spironolactone suppressed upregulated mineralocorticoid receptor (MR) target gene, serum and glucocorticoid-regulated kinases-1 mRNA expression in skeletal muscle in aldo+fruc rats. In conclusion, these data suggested that aldosterone aggravates fructose feeding-induced glucose intolerance through MR activation.
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Affiliation(s)
- Shamshad J Sherajee
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Jin HM, Zhou DC, Gu HF, Qiao QY, Fu SK, Liu XL, Pan Y. Antioxidant N-acetylcysteine protects pancreatic β-cells against aldosterone-induced oxidative stress and apoptosis in female db/db mice and insulin-producing MIN6 cells. Endocrinology 2013; 154:4068-77. [PMID: 24008345 DOI: 10.1210/en.2013-1115] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous studies have shown that primary aldosteronism is associated with glucose-related metabolic disorders. However, the mechanisms by which aldosterone (ALDO) triggers β-cell dysfunction remains unclear. This study aimed to investigate whether oxidative stress is involved in and whether the antioxidant N-acetylcysteine (NAC) or the mineralocorticoid receptor antagonist spironolactone (SPL) could prevent or delay β-cell damage in vivo and in vitro. As expected, 8 weeks after ALDO treatment, 12-week-old female diabetic db/db mice exhibited impaired oral glucose tolerance, decreased β-cell mass, and heightened levels of oxidative stress marker (urinary 8-hydroxy-2'-deoxyguanosine). NAC reversed these symptoms completely, whereas SPL treatment did so only partially. After exposure to ALDO, the mouse pancreatic β-cell line MIN6 exhibited decreased viability and increased caspase-3 activity, as well as reduced expression of Bcl-2/Bax and p-AKT, even if mineralocorticoid receptor was completely suppressed with small interfering RNA. NAC, but not SPL, suppressed oxidative stress in MIN6 cells, as revealed by the decrease in inducible NOS levels and expression of the proteins p22-phox and p67-phox. These findings suggest that oxidative stress may be involved in ALDO-induced β-cell dysfunction and that NAC, but not SPL, may protect pancreatic β-cells of mice from ALDO-induced oxidative stress and apoptosis in a manner independent of its receptor.
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Affiliation(s)
- Hui Min Jin
- Division of Nephrology, Shanghai No. 3 People's Hospital, Shanghai Jiao Tong University School of Medicine, 280 Mo He Road, Shanghai 201900, China.
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Marcus Y, Shefer G, Stern N. Adipose tissue renin-angiotensin-aldosterone system (RAAS) and progression of insulin resistance. Mol Cell Endocrinol 2013; 378:1-14. [PMID: 22750719 DOI: 10.1016/j.mce.2012.06.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/24/2012] [Indexed: 12/31/2022]
Abstract
This review focuses on the expression of the key components of the renin-angiotensin-aldosterone axis in fat tissue. At the center of this report is the role of RAAS in normal and excessive fat mass enlargement, the leading etiology of insulin resistance. Understanding the expression and regulation of RAAS components in various fat depots allows insight not only into the processes by which these complex patterns are modified by the enlargement of adipose tissue, but also into their impact on local and systemic response to insulin.
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Affiliation(s)
- Yonit Marcus
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
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Feraco A, Armani A, Mammi C, Fabbri A, Rosano GMC, Caprio M. Role of mineralocorticoid receptor and renin-angiotensin-aldosterone system in adipocyte dysfunction and obesity. J Steroid Biochem Mol Biol 2013; 137:99-106. [PMID: 23454117 DOI: 10.1016/j.jsbmb.2013.02.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/07/2013] [Accepted: 02/20/2013] [Indexed: 12/13/2022]
Abstract
The mineralocorticoid receptor (MR) classically mediates aldosterone effects on salt homeostasis and blood pressure regulation in epithelial target tissues. In recent years, functional MRs have been identified in non classical targets of aldosterone actions, in particular in adipose tissue, where they mediate the effects of aldosterone and glucocorticoids in the control of adipogenesis, adipose expansion and its pro-inflammatory capacity. In this context, inappropriate MR activation has been demonstrated to be a causal factor in several pathologic conditions such as vascular inflammation, endothelial dysfunction, insulin resistance and obesity. The aim of this review is to summarize the latest developments in this rapidly developing field, and will focus on the role of MR and renin-angiotensin-aldosterone system (RAAS) as potential leading characters in the early steps of adipocyte dysfunction and obesity. Indeed modulation of MR activity in adipose tissue has promise as a novel therapeutic approach to treat obesity and its related metabolic complications. This article is part of a Special Issue entitled 'CSR 2013'.
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Mayyas F, Alzoubi KH, Van Wagoner DR. Impact of aldosterone antagonists on the substrate for atrial fibrillation: aldosterone promotes oxidative stress and atrial structural/electrical remodeling. Int J Cardiol 2013; 168:5135-42. [PMID: 23993726 DOI: 10.1016/j.ijcard.2013.08.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/03/2013] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia, is an electrocardiographic description of a condition with multiple and complex underlying mechanisms. Oxidative stress is an important driver of structural remodeling that creates a substrate for AF. Oxidant radicals may promote increase of atrial oxidative damage, electrical and structural remodeling, and atrial inflammation. AF and other cardiovascular morbidities activate angiotensin (Ang-II)-dependent and independent cascades. A key component of the renin-angiotensin-aldosterone system (RAAS) is the mineralocorticoid aldosterone. Recent studies provide evidence of myocardial aldosterone synthesis. Aldosterone promotes cardiac oxidative stress, inflammation and structural/electrical remodeling via multiple mechanisms. In HF patients, aldosterone production is enhanced. In patients and in experimental HF and AF models, aldosterone receptor antagonists have favorable influences on cardiac remodeling and oxidative stress. Therapeutic approaches that seek to reduce AF burden by modulating the aldosterone system are likely beneficial but underutilized.
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Affiliation(s)
- Fadia Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Jordan.
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Rüster C, Wolf G. The role of the renin-angiotensin-aldosterone system in obesity-related renal diseases. Semin Nephrol 2013; 33:44-53. [PMID: 23374893 DOI: 10.1016/j.semnephrol.2012.12.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is an independent risk factor for the development and progression of chronic kidney disease and one of the emerging reasons for end-stage renal disease owing to its dramatic increase worldwide. Among the potential underlying pathophysiologic mechanisms, activation of the renin-angiotensin-aldosterone-system (RAAS) plays a central role. Increased angiotensin II (AngII) levels also are central in hypertension, dyslipidemia, and insulin resistance, which, taken together with obesity, represent the metabolic syndrome. Increased AngII levels contribute to hyperfiltration, glomerulomegaly, and subsequent focal glomerulosclerosis by altering renal hemodynamics via afferent arteriolar dilation, together with efferent renal arteriolar vasoconstriction as well as by its endocrine and paracrine properties linking the intrarenal and the systemic RAAS, adipose tissue dysfunction, as well as insulin resistance and hypertension. The imbalance between increased AngII levels and the angiotensin converting enzyme 2/Ang (1-7)/Mas receptor axis additionally contributes to renal injury in obesity and its concomitant metabolic disturbances. As shown in several large trials and experimental studies, treatment of obesity by weight loss is associated with an improvement of kidney disease because it also is beneficial in dyslipidemia, hypertension, and diabetes. The most promising data have been seen by RAAS blockade, pointing to the central position of RAAS within obesity, kidney disease, and the metabolic syndrome.
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Affiliation(s)
- Christiane Rüster
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
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Lastra G, Santos FR, Hooshmand P, Hooshmand P, Mugerfeld I, Aroor AR, Demarco VG, Sowers JR, Henriksen EJ. The Novel Angiotensin II Receptor Blocker Azilsartan Medoxomil Ameliorates Insulin Resistance Induced by Chronic Angiotensin II Treatment in Rat Skeletal Muscle. Cardiorenal Med 2013; 3:154-164. [PMID: 23922555 DOI: 10.1159/000353155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/23/2013] [Indexed: 12/19/2022] Open
Abstract
Angiotensin receptor (type 1) blockers (ARBs) can reduce both hypertension and insulin resistance induced by local and systemic activation of the renin-angiotensin-aldosterone system. The effectiveness of azilsartan medoxomil (AZIL-M), a novel imidazole-based ARB, to facilitate metabolic improvements in conditions of angiotensin II (Ang II)-associated insulin resistance is currently unknown. The aim of this study was to determine the impact of chronic AZIL-M treatment on glucose transport activity and key insulin signaling elements in red skeletal muscle of Ang II-treated rats. Male Sprague-Dawley rats were treated for 8 weeks with or without Ang II (200 ng/kg/min) combined with either vehicle or AZIL-M (1 mg/kg/day). Ang II induced significant (p < 0.05) increases in blood pressure, which were completely prevented by AZIL-M. Furthermore, Ang II reduced insulin-mediated glucose transport activity in incubated soleus muscle, and AZIL-M co-treatment increased this parameter. Moreover, AZIL-M treatment of Ang II-infused animals increased the absolute phosphorylation of insulin signaling molecules, including Akt [both Ser473 (81%) and Thr308 (23%)] and AS160 Thr642 (42%), in red gastrocnemius muscle frozen in situ. Absolute AMPKα (Thr172) phosphorylation increased (98%) by AZIL-M treatment, and relative Thr389 phosphorylation of p70 S6K1, a negative regulator of insulin signaling, decreased (51%) with AZIL-M treatment. These results indicate that ARB AZIL-M improves the in vitro insulin action on glucose transport in red soleus muscle and the functionality of the Akt/AS160 axis in red gastrocnemius muscle in situ in Ang II-induced insulin-resistant rats, with the latter modification possibly associated with enhanced AMPKα and suppressed p70 S6K1 activation.
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Affiliation(s)
- Guido Lastra
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Mo., USA ; Diabetes and Cardiovascular Laboratory, University of Missouri School of Medicine, Columbia, Mo., USA
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Luo P, Dematteo A, Wang Z, Zhu L, Wang A, Kim HS, Pozzi A, Stafford JM, Luther JM. Aldosterone deficiency prevents high-fat-feeding-induced hyperglycaemia and adipocyte dysfunction in mice. Diabetologia 2013; 56:901-10. [PMID: 23314847 PMCID: PMC3593801 DOI: 10.1007/s00125-012-2814-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS Obesity is associated with aldosterone excess, hypertension and the metabolic syndrome, but the relative contribution of aldosterone to obesity-related complications is debated. We previously demonstrated that aldosterone impairs insulin secretion, and that genetic aldosterone deficiency increases glucose-stimulated insulin secretion in vivo. We hypothesised that elimination of endogenous aldosterone would prevent obesity-induced insulin resistance and hyperglycaemia. METHODS Wild-type and aldosterone synthase-deficient (As (-/-)) mice were fed a high-fat (HF) or normal chow diet for 12 weeks. We assessed insulin sensitivity and insulin secretion using clamp methodology and circulating plasma adipokines, and examined adipose tissue via histology. RESULTS HF diet induced weight gain similarly in the two groups, but As (-/-) mice were protected from blood glucose elevation. HF diet impaired insulin sensitivity similarly in As (-/-) and wild-type mice, assessed by hyperinsulinaemic-euglycaemic clamps. Fasting and glucose-stimulated insulin were higher in HF-fed As (-/-) mice than in wild-type controls. Although there was no difference in insulin sensitivity during HF feeding in As (-/-) mice compared with wild-type controls, fat mass, adipocyte size and adiponectin increased, while adipose macrophage infiltration decreased. HF feeding significantly increased hepatic steatosis and triacylglycerol content in wild-type mice, which was attenuated in aldosterone-deficient mice. CONCLUSIONS/INTERPRETATION These studies demonstrate that obesity induces insulin resistance independently of aldosterone and adipose tissue inflammation, and suggest a novel role for aldosterone in promoting obesity-induced beta cell dysfunction, hepatic steatosis and adipose tissue inflammation.
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Affiliation(s)
- P. Luo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, 2200 Pierce Avenue, 560 RRB, Nashville, TN 37232-6602, USA. Huangshi Central Hospital, Huangshi, Hubei Province, People’s Republic of China
| | - A. Dematteo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, 2200 Pierce Avenue, 560 RRB, Nashville, TN 37232-6602, USA
| | - Z. Wang
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, 2200 Pierce Avenue, 560 RRB, Nashville, TN 37232-6602, USA
| | - L. Zhu
- Division of Endocrinology and Diabetes, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. Department of Veterans Affairs, Nashville, TN, USA
| | - A. Wang
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - H.-S. Kim
- Departments of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - A. Pozzi
- Department of Veterans Affairs, Nashville, TN, USA. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J. M. Stafford
- Division of Endocrinology and Diabetes, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. Department of Veterans Affairs, Nashville, TN, USA
| | - J. M. Luther
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, 2200 Pierce Avenue, 560 RRB, Nashville, TN 37232-6602, USA. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Kopp C, Linz P, Dahlmann A, Hammon M, Jantsch J, Müller DN, Schmieder RE, Cavallaro A, Eckardt KU, Uder M, Luft FC, Titze J. 23Na magnetic resonance imaging-determined tissue sodium in healthy subjects and hypertensive patients. Hypertension 2013; 61:635-40. [PMID: 23339169 DOI: 10.1161/hypertensionaha.111.00566] [Citation(s) in RCA: 290] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High dietary salt intake is associated with hypertension; the prevalence of salt-sensitive hypertension increases with age. We hypothesized that tissue Na(+) might accumulate in hypertensive patients and that aging might be accompanied by Na(+) deposition in tissue. We implemented (23)Na magnetic resonance imaging to measure Na(+) content of soft tissues in vivo earlier, but had not studied essential hypertension. We report on a cohort of 56 healthy control men and women, and 57 men and women with essential hypertension. The ages ranged from 22 to 90 years. (23)Na magnetic resonance imaging measurements were made at the level of the calf. We observed age-dependent increases in Na(+) content in muscle in men, whereas muscle Na(+) content did not change with age in women. We estimated water content with conventional MRI and found no age-related increases in muscle water in men, despite remarkable Na(+) accumulation, indicating water-free Na(+) storage in muscle. With increasing age, there was Na(+) deposition in the skin in both women and men; however, skin Na(+) content remained lower in women. Similarly, this sex difference was found in skin water content, which was lower in women than in men. In contrast to muscle, increasing Na(+) content was paralleled with increasing skin water content. When controlled for age, we found that patients with refractory hypertension had increased tissue Na(+) content, compared with normotensive controls. These observations suggest that (23)Na magnetic resonance imaging could have utility in assessing the role of tissue Na(+) storage for cardiovascular morbidity and mortality in longitudinal studies.
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Affiliation(s)
- Christoph Kopp
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN 37232, USA
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Laffer CL, Elijovich F. Differential predictors of insulin resistance in nondiabetic salt-resistant and salt-sensitive subjects. Hypertension 2013; 61:707-15. [PMID: 23283360 DOI: 10.1161/hypertensionaha.111.00423] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We studied the characteristics of insulin resistance in 19 normotensive and 25 hypertensive subjects who underwent an acute protocol for determination of salt-sensitivity of blood pressure. Hypertensive subjects were older and more obese, with higher creatinine, lipids, and aldosterone than normotensive volunteers. They also had higher glucose and insulin levels with a marked decrease in insulin sensitivity (HOMA2-S index). Once all participants were classified into salt-sensitive (SS) and salt-resistant (SR) groups, most of these differences were no longer present. In contrast, SS had classical characteristics of this phenotype (higher percentage of blacks, suppressed plasma renin, increased aldosterone-to-renin ratio, and blunted renin and aldosterone responses to changes in salt balance). Despite similar insulin levels, HOMA2-S was significantly lower in SS than SR. Salt-loading did not change HOMA2-S in SS or SR. In contrast, salt-depletion, by significantly increasing glucose and insulin of SR, decreased their HOMA2-S to the levels observed in SS. Correlates of insulin resistance in SR included age, triglycerides, body mass index, mean arterial pressure, aldosterone, and epinephrine. However, only body mass index and aldosterone remained as significant predictors in multivariate analyses. Correlates of insulin resistance in SS were mean arterial pressure, epinephrine, and norepinephrine, all remaining as significant predictors in multivariate modeling. Our data confirm that salt-sensitivity of blood pressure is associated with insulin resistance, suggest that salt restriction may be beneficial in SS but perhaps detrimental in SR subjects, and uncover possible differences in mechanisms of insulin resistance between SS and SR, with implications for pharmacological therapy.
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Affiliation(s)
- Cheryl L Laffer
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-6602, USA.
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dos Santos PP, Nogueira BF, Rafacho BPM, Azevedo PS, Polegato BF, Chiuso-Minicucci F, Bonomo C, Roscani MG, Zorzella-Pezavento SFG, Tanni SE, Pereira EJ, Okoshi MP, Paiva SAR, Zornoff LAM, Minicucci MF. Aldosterone is not involved in the ventricular remodeling process induced by tobacco smoke exposure. Cell Physiol Biochem 2012; 30:1191-201. [PMID: 23052290 DOI: 10.1159/000343309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Renin-angiotensin-aldosterone system blockade with a mineralocorticoid-receptor antagonist has not yet been studied in exposure to tobacco smoke (TS) models. Thus, this study investigated the role of spironolactone on cardiac remodeling induced by exposure to tobacco smoke. METHODS Male Wistar rats were divided into 4 groups: a control group (group C, n=11); a group with 2 months of cigarette smoke exposure (group TS-C, n=13); a group that received spironolactone 20 mg/kg of diet/day and no cigarette smoke exposure (group TS-S, n=13); and a group with 2 months of cigarette smoke exposure and spironolactone supplementation (group S, n=12). The rats were observed for a period of 60 days, during which morphological, biochemical and functional analyses were performed. RESULTS There was no difference in invasive mean arterial pressure among the groups. There were no interactions between tobacco smoke exposure and spironolactone in the morphological and functional analysis. However, in the echocardiographic analysis, the TS groups had left chamber enlargement, higher left ventricular mass index and higher isovolumetric relaxation time corrected by heart rate compared with the non-TS groups. In vitro left ventricular diastolic function also worsened in the TS groups and was not influenced by spironolactone. In addition, there were no differences in myocardial levels of IFN-γ, TNF-α, IL-10, ICAM-1 and GLUT4 [TS: OR 0.52, 95%CI (-0.007; 0.11); Spironolactone: OR -0.01, 95%CI (-0.07;0.05)]. CONCLUSION Our data do not support the participation of aldosterone in the ventricular remodeling process induced by exposed to cigarette smoke.
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Affiliation(s)
- Priscila P dos Santos
- Internal Medicine Department, Botucatu Medical School, Univ Estadual Paulista (UNESP), Botucatu, Brazil
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Kulshreshtha B, Gupta N, Ganie MA, Ammini AC. Effect of metformin and spironolactone therapy on OGTT in patients with polycystic ovarian syndrome - a retrospective analysis. Gynecol Endocrinol 2012; 28:823-6. [PMID: 22475072 DOI: 10.3109/09513590.2012.671394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Metformin (an insulin sensitizer) and spironolactone (an antiandrogen) are both used for treatment of polycystic ovary syndrome. We analyzed the effect of 6 months of therapy with these drugs on body weight and glucose tolerance. RESULTS This was a retrospective analysis of polycystic ovarian syndrome (PCOS) cases on treatment. There were 88 patients with PCOS-42 were on metformin 1 g daily and 46 were taking spironolactone 50-75 mg daily. 21 of 42 had abnormal glucose tolerance (AGT) in the metformin group and 13 of 46 had AGT in the spironolactone group. Patients on metformin reported a greater reduction in body weight, whereas there was no change in body weight with spironolactone therapy (67.6-63.7 versus 59.6-59.2 kg). There was a significant reduction in the 1 and 2 h glucose and insulin levels with metformin therapy in those with AGT. However, fasting glucose increased in those with normal glucose tolerance. There was no change in either body weight or insulin levels with spironolactone. But, there was a significant reduction in both the 0 and 2 h glucose with spironolactone also in those with AGT. CONCLUSION Spironolactone and metformin had similar effect in reducing the glucose levels in PCOS patients with AGT. PCOS patients with normal glucose tolerance had higher fasting plasma glucose at the end of 6 months of metformin therapy inspite of weight reduction.
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Boscaro M, Giacchetti G, Ronconi V. Visceral adipose tissue: emerging role of gluco- and mineralocorticoid hormones in the setting of cardiometabolic alterations. Ann N Y Acad Sci 2012; 1264:87-102. [PMID: 22804097 PMCID: PMC3464353 DOI: 10.1111/j.1749-6632.2012.06597.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several clinical and experimental lines of evidence have highlighted the detrimental effects of visceral adipose tissue excess on cardiometabolic parameters. Besides, recent findings have shown the effects of gluco-and mineralocorticoid hormones on adipose tissue and have also underscored the interplay existing between such adrenal steroids and their respective receptors in the modulation of adipose tissue biology. While the fundamental role played by glucocorticoids on adipocyte differentiation and storage was already well known, the relevance of the mineralocorticoids in the physiology of the adipose organ is of recent acquisition. The local and systemic renin–angiotensin–aldosterone system (RAAS) acting on adipose tissue seems to contribute to the development of the cardiometabolic phenotype so that its modulation can have deep impact on human health. A better understanding of the pathophysiology of the adipose organ is of crucial importance in order to identify possible therapeutic approaches that can avoid the development of such cardiovascular and metabolic sequelae.
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Affiliation(s)
- Marco Boscaro
- Division of Endocrinology, Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi," Università Politecnica delle Marche, Ancona, Italy
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The link between the renin-angiotensin-aldosterone system and renal injury in obesity and the metabolic syndrome. Curr Hypertens Rep 2012; 14:160-9. [PMID: 22302531 DOI: 10.1007/s11906-012-0245-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Obesity is a risk factor for type 2 diabetes mellitus (DM) and is associated with chronic kidney disease. Activation of the renin-angiotensin-aldosterone system (RAAS) is common in obesity. The RAAS is an important mediator of hypertension. Mechanisms involved in activation of the RAAS in obesity include sympathetic stimulation, synthesis of adipokines in the RAAS by visceral fat, and hemodynamic alterations. The RAAS is known for its role in regulating blood pressure and fluid and electrolyte homeostasis. The role of local/tissue RAAS in specific tissues has been a focus of research. Urinary angiotensinogen (UAGT) provides a specific index of the intrarenal RAAS. Investigators have demonstrated that sex steroids can modulate the expression and activity of the different components of the intrarenal RAAS and other tissues. Our data suggest that obese women without DM and hypertension have significantly higher levels of UAGT than their male counterparts. These differences existed without any background difference in the ratio of microalbumin to creatinine in the urine or the estimated glomerular filtration rate, raising a question about the importance of baseline gender differences in the endogenous RAAS in the clinical spectrum of cardiovascular diseases and the potential utility of UAGT as a marker of the intrarenal RAAS. Animal studies have demonstrated that modifying the amount of angiotensin, the biologically active component of the RAAS, directly influences body weight and adiposity. This article reviews the role of the RAAS in renal injury seen in obesity and the metabolic syndrome.
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Manrique C, Lastra G, Habibi J, Mugerfeld I, Garro M, Sowers JR. Loss of Estrogen Receptor α Signaling Leads to Insulin Resistance and Obesity in Young and Adult Female Mice. Cardiorenal Med 2012; 2:200-210. [PMID: 22969776 DOI: 10.1159/000339563] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 05/16/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS: There are important sex-related differences in the prevalence of obesity, type 2 diabetes mellitus and cardiovascular disease. Indeed, premenopausal women have a lower prevalence of these conditions relative to age-matched men. Estrogen participates in the modulation of insulin sensitivity, energy balance, and body composition. In this paper, we investigated the impact of estrogen signaling through estrogen receptor α (ERα) on systemic insulin sensitivity and insulin signaling in skeletal muscle. METHODS: In 14- and 30-week-old female ERα knockout (ERαKO) mice and age-matched controls, we assessed insulin sensitivity by a euglycemic-hyperinsulinemic clamp and intraperitoneal glucose tolerance testing. Blood pressure was evaluated by tail cuff and telemetry. We studied ex vivo insulin-stimulated glucose uptake in skeletal muscle tissue, as well as insulin metabolic signaling molecule phosphorylation by immunoblotting and oxidative stress by immunostaining for 3-nitrotyrosine. RESULTS: Body weight was higher in ERαKO mice at 14 and 30 weeks of age. At 30 weeks, intraperitoneal glucose tolerance testing and clamp results demonstrated impaired systemic insulin sensitivity in ERαKO mice. Insulin-stimulated glucose uptake in soleus was lower in ERαKO mice at both ages. The insulin receptor substrate 1/phosphatidylinositol 3-kinase association and the activation of protein kinase B were decreased in ERαKO mice, whereas immunostaining for 3-nitrotyrosine was increased. CONCLUSIONS: Our data demonstrate a critical age-dependent role for estrogen signaling through ERα on whole-body insulin sensitivity and insulin metabolic signaling in skeletal muscle tissue. These findings have potential translational implications for the prevention and management of type 2 diabetes mellitus and cardiovascular disease in women, who are at increased risk for these conditions.
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Affiliation(s)
- Camila Manrique
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, Mo., USA
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Exercise in the metabolic syndrome. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2012; 2012:349710. [PMID: 22829955 PMCID: PMC3399489 DOI: 10.1155/2012/349710] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023]
Abstract
The metabolic syndrome is a clustering of obesity, diabetes, hyperlipidemia, and hypertension that is occurring in increasing frequency across the global population. Although there is some controversy about its diagnostic criteria, oxidative stress, which is defined as imbalance between the production and inactivation of reactive oxygen species, has a major pathophysiological role in all the components of this disease. Oxidative stress and consequent inflammation induce insulin resistance, which likely links the various components of this disease. We briefly review the role of oxidative stress as a major component of the metabolic syndrome and then discuss the impact of exercise on these pathophysiological pathways. Included in this paper is the effect of exercise in reducing fat-induced inflammation, blood pressure, and improving muscular metabolism.
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