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Mannaa M, Pfennigwerth P, Fielitz J, Gollasch M, Boschmann M. Mammalian target of rapamycin inhibition impacts energy homeostasis and induces sex-specific body weight loss in humans. J Cachexia Sarcopenia Muscle 2023; 14:2757-2767. [PMID: 37897143 PMCID: PMC10751400 DOI: 10.1002/jcsm.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Previous data from a 2-year randomized controlled trial (CRAD001ADE12) indicated that mammalian target of rapamycin (mTOR) inhibition by everolimus slowed cyst growth in patients with autosomal-dominant polycystic kidney disease (ADPKD). During the trial, we noted body weight loss in some patients, particularly in women. We hypothesized that everolimus causes body weight reduction by reduced food intake and/or metabolic changes, which could lead to cachexia. METHODS Within a sub-analysis of the CRAD001ADE12 trial, body weight course was investigated regarding sex-specific differences in 433 adult ADPKD patients (everolimus, n = 215; placebo, n = 218). One hundred four out of 111 patients who participated in the clinical trial centre in Berlin were evaluated under everolimus/placebo therapy (on drug: everolimus, n = 48; placebo, n = 56) and after therapy (off drug: everolimus, n = 15; placebo, n = 18). Eating habits and nutrient/caloric intake were evaluated by validated questionnaires. Systemic and local metabolism was evaluated in four patients after an oral glucose load (OGL) by using calorimetry and adipose/muscle tissue microdialysis. RESULTS Within the 2-year CRAD001ADE12 trial, a significant body weight loss was observed in female patients on everolimus versus placebo (P = 0.0029). Data of the Berlin Cohort revealed that weight loss was greater in women on everolimus versus men (P < 0.01). After 9 months, women and men had lost 2.6 ± 3.8 and 0.8 ± 1.5 kg (P < 0.05) in body weight, respectively, and after 21 months, they had lost 4.1 ± 6.6 and 1.0 ± 3.3 kg (P < 0.05), respectively. On everolimus, caloric intake was significantly lower in women versus men (1510 ± 128 vs. 2264 ± 216 kcal/day, P < 0.05), caused mainly by a lower fat and protein intake in women versus men. Cognitive restraints, disinhibition and hunger remained unchanged. In a subgroup of patients resting metabolic rate was unchanged whereas OGL-induced thermogenesis was reduced (7 ± 2 vs. 11 ± 2 kcal, P < 0.05). Fasting and OGL-induced fat oxidation was increased (P < 0.05) on versus off everolimus. In adipose tissue, fasting lipolytic activity was increased, but lipolytic activity was inhibited similarly after the OGL on versus off everolimus, respectively. In skeletal muscle, postprandial glucose uptake and aerobic glycolysis was reduced in patients on everolimus. CONCLUSIONS mTOR inhibition by everolimus induces body weight reduction, specifically in female patients. This effect is possibly caused by a centrally mediated reduced food (fat and protein) intake and by centrally/peripherally mediated increased fat oxidation (systemic) and mobilization (adipose tissue). Glucose uptake and oxidation might be reduced in skeletal muscle. This could lead to cachexia and, possibly, muscle wasting. Therefore, our results have important implications for patients recieving immune-suppressive mTOR inhibition therapy.
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Affiliation(s)
- Marwan Mannaa
- Department of Internal Medicine and GeriatricsUniversitätsmedizin GreifswaldGreifswaldGermany
| | - Pia Pfennigwerth
- Experimental and Clinical Research Center, a co‐operation between Charité – Universitätsmedizin and the Max Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
| | - Jens Fielitz
- Klinik und Poliklinik für Innere Medizin BUniversitätsmedizin GreifswaldGreifswaldGermany
- DZHK (German Center for Cardiovascular Research), partner site GreifswaldGreifswaldGermany
| | - Maik Gollasch
- Department of Internal Medicine and GeriatricsUniversitätsmedizin GreifswaldGreifswaldGermany
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin BerlinBerlinGermany
| | - Michael Boschmann
- Experimental and Clinical Research Center, a co‐operation between Charité – Universitätsmedizin and the Max Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
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Borghi F, Morais CL, Silva C, da Silva PC, Grassi-Kassisse DM. The influence of angiotensin II and RAAS blockers on lipolytic and glycolytic activity in isolated adipocytes from Wistar, Wistar-Kyoto and Spontaneously Hypertensive Rats. Mol Cell Endocrinol 2021; 520:111086. [PMID: 33221332 DOI: 10.1016/j.mce.2020.111086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
The renin-angiotensin-aldosterone system (RAAS) is related to dysfunctional adipose tissue, but the actions of angiotensin II (AII) in adipocytes remains unclear. This study aimed to investigate the effects of RAAS blockers and AII in lipolysis and glycolysis from isolated adipocytes in Wistar (WIS), Wistar-Kyoto (WKY) and Spontaneously Hypertensive Rats (SHR). Adipocytes from 15-weeks-old WIS, WKY and SHR were incubated with AII (10-17 M to 10-6 M) and noradrenaline (NOR - 10-10 M to 10-4 M) in presence or not of antagonists (Losartan Potassium 10-4 M, PD 123319 5.6 nM or co-incubation). Glycerol and lactate production in WIS and WKY were not affected by the RAAS blockade. SHR glycerol was attenuated by the blockers but lactate was not affected. NOR induced increase in glycerol from 10-7 M for all strains. Normotensive rats are not affected by blockers but decreased lipolytic activity ins SHR. The SHR hypolipodistrophy cannot be related to any disturbance in lipolytic or glycolytic upstream pathways.
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Affiliation(s)
- Filipy Borghi
- LABEEST - Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Zip Code: 13083-862, Campinas, SP, Brazil
| | - Camila Lidiane Morais
- LABEEST - Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Zip Code: 13083-862, Campinas, SP, Brazil
| | - Carolina Silva
- LABEEST - Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Zip Code: 13083-862, Campinas, SP, Brazil
| | - Priscila Cristina da Silva
- LABEEST - Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Zip Code: 13083-862, Campinas, SP, Brazil
| | - Dora Maria Grassi-Kassisse
- LABEEST - Laboratory of Stress Study, Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Zip Code: 13083-862, Campinas, SP, Brazil.
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3
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Stinkens R, van der Kolk BW, Jordan J, Jax T, Engeli S, Heise T, Jocken JW, May M, Schindler C, Havekes B, Schaper N, Albrecht D, Kaiser S, Hartmann N, Letzkus M, Langenickel TH, Goossens GH, Blaak EE. The effects of angiotensin receptor neprilysin inhibition by sacubitril/valsartan on adipose tissue transcriptome and protein expression in obese hypertensive patients. Sci Rep 2018; 8:3933. [PMID: 29500454 PMCID: PMC5834447 DOI: 10.1038/s41598-018-22194-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/19/2018] [Indexed: 01/30/2023] Open
Abstract
Increased activation of the renin-angiotensin system is involved in the onset and progression of cardiometabolic diseases, while natriuretic peptides (NP) may exert protective effects. We have recently demonstrated that sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, which blocks the angiotensin II type-1 receptor and augments natriuretic peptide levels, improved peripheral insulin sensitivity in obese hypertensive patients. Here, we investigated the effects of sacubitril/valsartan (400 mg QD) treatment for 8 weeks on the abdominal subcutaneous adipose tissue (AT) phenotype compared to the metabolically neutral comparator amlodipine (10 mg QD) in 70 obese hypertensive patients. Abdominal subcutaneous AT biopsies were collected before and after intervention to determine the AT transcriptome and expression of proteins involved in lipolysis, NP signaling and mitochondrial oxidative metabolism. Both sacubitril/valsartan and amlodipine treatment did not significantly induce AT transcriptional changes in pathways related to lipolysis, NP signaling and oxidative metabolism. Furthermore, protein expression of adipose triglyceride lipase (ATGL) (Ptime*group = 0.195), hormone-sensitive lipase (HSL) (Ptime*group = 0.458), HSL-ser660 phosphorylation (Ptime*group = 0.340), NP receptor-A (NPRA) (Ptime*group = 0.829) and OXPHOS complexes (Ptime*group = 0.964) remained unchanged. In conclusion, sacubitril/valsartan treatment for 8 weeks did not alter the abdominal subcutaneous AT transcriptome and expression of proteins involved in lipolysis, NP signaling and oxidative metabolism in obese hypertensive patients.
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Affiliation(s)
- R Stinkens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - B W van der Kolk
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J Jordan
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.,Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - T Jax
- Profil GmbH, Neuss, Germany
| | - S Engeli
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | | | - J W Jocken
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M May
- Clinical Research Center Hannover, Hannover Medical School, Hannover, Germany
| | - C Schindler
- Clinical Research Center Hannover, Hannover Medical School, Hannover, Germany
| | - B Havekes
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - N Schaper
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D Albrecht
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - S Kaiser
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - N Hartmann
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - M Letzkus
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - T H Langenickel
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - G H Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - E E Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.
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4
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Engeli S, Stinkens R, Heise T, May M, Goossens GH, Blaak EE, Havekes B, Jax T, Albrecht D, Pal P, Tegtbur U, Haufe S, Langenickel TH, Jordan J. Effect of Sacubitril/Valsartan on Exercise-Induced Lipid Metabolism in Patients With Obesity and Hypertension. Hypertension 2017; 71:70-77. [PMID: 29180454 PMCID: PMC5753808 DOI: 10.1161/hypertensionaha.117.10224] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/11/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Sacubitril/valsartan (LCZ696), a novel angiotensin receptor-neprilysin inhibitor, was recently approved for the treatment of heart failure with reduced ejection fraction. Neprilysin degrades several peptides that modulate lipid metabolism, including natriuretic peptides. In this study, we investigated the effects of 8 weeks’ treatment with sacubitril/valsartan on whole-body and adipose tissue lipolysis and lipid oxidation during defined physical exercise compared with the metabolically neutral comparator amlodipine. This was a multicenter, randomized, double-blind, active-controlled, parallel-group study enrolling subjects with abdominal obesity and moderate hypertension (mean sitting systolic blood pressure ≥130–180 mm Hg). Lipolysis during rest and exercise was assessed by microdialysis and [1,1,2,3,3-2H]-glycerol tracer kinetics. Energy expenditure and substrate oxidation were measured simultaneously using indirect calorimetry. Plasma nonesterified fatty acids, glycerol, insulin, glucose, adrenaline and noradrenaline concentrations, blood pressure, and heart rate were also determined. Exercise elevated plasma glycerol, free fatty acids, and interstitial glycerol concentrations and increased the rate of glycerol appearance. However, exercise-induced stimulation of lipolysis was not augmented on sacubitril/valsartan treatment compared with amlodipine treatment. Furthermore, sacubitril/valsartan did not alter energy expenditure and substrate oxidation during exercise compared with amlodipine treatment. In conclusion, sacubitril/valsartan treatment for 8 weeks did not elicit clinically relevant changes in exercise-induced lipolysis or substrate oxidation in obese patients with hypertension, implying that its beneficial cardiovascular effects cannot be explained by changes in lipid metabolism during exercise.
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Affiliation(s)
- Stefan Engeli
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Rudi Stinkens
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Tim Heise
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Marcus May
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Gijs H Goossens
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Ellen E Blaak
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Bas Havekes
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Thomas Jax
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Diego Albrecht
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Parasar Pal
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Uwe Tegtbur
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Sven Haufe
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Thomas H Langenickel
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Jens Jordan
- From the Institute of Clinical Pharmacology (S.E., M.M., S.H., J.J.), Institute of Sports Medicine (U.T.), Hannover Medical School, Germany; Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism (R.S., G.H.G., E.E.B.), Division of Endocrinology, Department of Internal Medicine (B.H.), Maastricht University Medical Center, The Netherlands; Profil, Neuss, Germany (T.H., T.J.); Translational Medicine, Novartis Pharma AG, Basel, Switzerland (D.A., T.H.L.); Biostatistical Sciences, Integrated Development Functions and Regions, Novartis Healthcare Pvt. Ltd, Hyderabad, India (P.P.); and Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, University of Cologne, Germany (J.J.).
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Systemic and tissue-specific effects of aliskiren on the RAAS and carbohydrate/lipid metabolism in obese patients with hypertension. ACTA ACUST UNITED AC 2017; 11:488-497. [PMID: 28666704 DOI: 10.1016/j.jash.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/04/2017] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
Abstract
Aliskiren penetrates adipose and skeletal muscle in hypertensive patients with abdominal obesity and reduces renin-angiotensin-aldosterone system activity. After discontinuation, blood pressure-lowering effects are observed possibly through drug-tissue binding. We performed microdialysis evaluation of adipose tissue and skeletal muscle before and during an insulin-modified frequently sampled intravenous glucose tolerance test (IM-FSIGT). Aliskiren 300 mg (n = 8) or amlodipine 5 mg (n = 8) once daily were administered during a 12-week randomized treatment period. Aliskiren elicited variable changes in median interstitial angiotensin II (Ang II) in adipose (2.60-1.30 fmol/mL) and skeletal muscle (2.23-0.68 fmol/mL); amlodipine tended to increase adipose and skeletal muscle Ang II (P = .066 for skeletal muscle treatment difference). Glucose/insulin increased median plasma Ang II 1 hour after glucose injection (1.04-2.50 fmol/mL; P = .001), which was markedly attenuated by aliskiren but not amlodipine. Aliskiren increased glucose disposition index (P = .012) and tended to increase acute insulin response to glucose (P = .067). Fasting adipose glycerol (-17%; P = .064) and fasting muscle glucose dialysate (-17%; P = .025) were decreased by aliskiren but not amlodipine. In summary, aliskiren decreased Ang II production in response to glucose/insulin stimulus and elicited metabolic effects in adipose and skeletal muscle suggestive of increased whole-body glucose utilization.
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May M, Ahrens J, Menne J, Haller H, Beige J, Eckert S, Jordan J, Engeli S. Limited acute influences of electrical baroreceptor activation on insulin sensitivity and glucose delivery: a randomized, double-blind, crossover clinical study. Diabetes 2014; 63:2833-7. [PMID: 24647740 DOI: 10.2337/db13-1651] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Arterial baroreflexes may regulate resistance vessels supplying glucose to skeletal muscle by modulating efferent sympathetic nervous system activity. We hypothesized that selective manipulation of baroreflex activity through electrical carotid sinus stimulation influences insulin sensitivity by changing muscular glucose delivery. We enrolled 16 hypertensive patients who responded to treatment with an electrical carotid sinus stimulator. Patients were submitted to a frequently sampled intravenous glucose tolerance test (FSIGT) with the stimulator on and with the stimulator off on separate days in a randomized, double-blind, crossover study. We monitored interstitial glucose, lactate, and pyruvate in the vastus lateralis muscle using microdialysis. Glucose and insulin concentrations in arterialized venous blood before and during FSIGT were virtually identical with the stimulator on and with the stimulator off. Insulin sensitivity, the primary end point of this study, was 3.3 ± 1.0 (mU/L)(-1) ⋅ min(-1) and 4.4 ± 2.6 (mU/L)(-1) ⋅ min(-1) (on vs. off; P = 0.7). Interstitial glucose, lactate, and pyruvate increased similarly during FSIGT regardless of the stimulator settings. In conclusion, acute changes in baroreceptor stimulation did not elicit significant changes in muscular glucose delivery and whole-body insulin sensitivity. Baroreflex-mediated changes in sympathetic vasomotor tone may have a limited acute effect on muscle glucose metabolism in patients with treatment-resistant hypertension.
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Affiliation(s)
- Marcus May
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Jelka Ahrens
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Jan Menne
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Joachim Beige
- Department of Nephrology, St. Georg Clinic, Leipzig, Germany
| | - Siegfried Eckert
- Heart and Diabetes Center Nodrhein-Westfalen, Bad Oeynhausen, Germany
| | - Jens Jordan
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Stefan Engeli
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
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7
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Hemmrich K, Paul NE, Pallua N. The nitric oxide system--cure for shortcomings in adipose tissue engineering? J Tissue Eng Regen Med 2012; 6 Suppl 3:S1-3. [PMID: 22888023 DOI: 10.1002/term.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/04/2012] [Accepted: 04/18/2012] [Indexed: 11/07/2022]
Abstract
Adipose tissue engineering aims to grow fat tissue for soft tissue reconstruction after tumour resection or trauma. However, insufficient progenitor cell differentiation and poor vascularization compromise the generation of clinically applicable adipose tissue. The desired process of neo-adipogenesis seems to be difficult to mimic, even though it takes place in all of us, inevitably and rapidly, as soon as we start consuming high-caloric diets. It has previously been proposed that inflammation and its key regulator, nitric oxide (NO), may play a relevant part in neo-adipogenesis. We here discuss how a controlled activation of the nitric oxide system on various levels may represent a cure for several current shortcomings in adipose tissue engineering.
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Affiliation(s)
- Karsten Hemmrich
- Department of Plastic Surgery and Hand Surgery, Burn Centre, University Hospital of RWTH Aachen University of Technology, Aachen, Germany.
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Ferreira ADS, Oliveira JFD, Cordovil I, Barbosa Filho J. Quadriceps short-term resistance exercise in subjects with resistant hypertension. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000400006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Resistant arterial hypertension may lead to muscle disuse and reduced functional capacity due to arterial and target-organs lesions. The main objective of this work is to evaluate the quadriceps strength and fatigue tolerance after a program of resistance exercise in subjects with resistant primary hypertension. METHODS: Six patients under pharmacological treatment were submitted to a four-week resistance exercise training program for the quadriceps (8-14 repetitions, 3 sets, 3 days per week). Strength was evaluated by isometric dynamometry, as the percentage change in maximum voluntary contraction over the four week program. Fatigue was analyzed by surface electromyography, as the change in both root mean square value and intercept of median frequency slope of vastus medialis and vastus lateralis. RESULTS: Significant increase in the maximum voluntary contraction was observed (p = 0.04). Fatigue tolerance was not improved as seen by root mean square as well as in the intercept of median frequency (p > 0.05). Additionally, no significant changes were observed in resting arterial blood pressure and heart rate throughout the training period. CONCLUSION: The prescribed protocol seemed to successfully increase localized muscle strength without negatively affecting the monitored cardiovascular variables in patients with resistant hypertension under pharmacological treatment.
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Fujita K, Wada K, Nozaki Y, Yoneda M, Endo H, Takahashi H, Kirikoshi H, Inamori M, Kobayashi N, Kubota K, Saito S, Nakajima A. Serum nitric oxide metabolite as a biomarker of visceral fat accumulation: clinical significance of measurement for nitrate/nitrite. Med Sci Monit 2011; 17:CR123-31. [PMID: 21358598 PMCID: PMC3524723 DOI: 10.12659/msm.881445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/01/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A visceral fat area of more than 100 cm2 as measured by computed tomography (CT) at the umbilical level has been included as a criterion for obesity in all the proposed criteria for metabolic syndrome. However, CT cannot be used frequently because of radiation exposure. We evaluated the usefulness of measurement of the serum levels of nitric oxide (NO), instead of CT and the waist circumference, as a marker of abdominal visceral fat accumulation. MATERIAL/METHODS The study was carried out in 80 subjects. The serum levels of NO metabolites (nitrate/nitrite) were measured using the Griess reagent. RESULTS Simple and multiple regression analysis revealed that the serum levels of NO metabolites showed the greatest degree of correlation with the visceral fat area (r = 0.743, p<0.0001), and corresponded to a visceral fat area of 100 cm2, as determined using the ROC curve, was 21.0 µmol/ml (sensitivity 88%, specificity 82%); this method was more sensitive than the waist circumference for evaluation of the visceral fat accumulation. CONCLUSIONS Measurement of the serum levels of NO metabolites may be a simple, safe, convenient and reliable method for the evaluation of visceral fat accumulation in clinical diagnostic screening.
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Affiliation(s)
- Koji Fujita
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Koichiro Wada
- Department of Pharmacology, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Yuichi Nozaki
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Masato Yoneda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Hiroki Endo
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Hirokazu Takahashi
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Kirikoshi
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Masahiko Inamori
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Noritoshi Kobayashi
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Kensuke Kubota
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Satoru Saito
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Atsushi Nakajima
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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Boschmann M, Engeli S, Moro C, Luedtke A, Adams F, Gorzelniak K, Rahn G, Mähler A, Dobberstein K, Krüger A, Schmidt S, Spuler S, Luft FC, Smith SR, Schmidt HHJ, Jordan J. LMNA mutations, skeletal muscle lipid metabolism, and insulin resistance. J Clin Endocrinol Metab 2010; 95:1634-43. [PMID: 20130076 PMCID: PMC2853996 DOI: 10.1210/jc.2009-1293] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Type 2 familial partial lipodystrophy (FPLD) is an autosomal-dominant lamin A/C-related disease associated with exercise intolerance, muscular pain, and insulin resistance. The symptoms may all be explained by defective metabolism; however, metabolism at the tissue level has not been investigated. OBJECTIVE We hypothesized that in FPLD, insulin resistance and impaired aerobic exercise capacity are explained by a common underlying mechanism, presumably a muscular metabolic defect. PATIENTS AND METHODS Carbohydrate and lipid metabolism was studied on 10 FPLD patients, one patient with limb-girdle muscular dystrophy (LGMD1B, a different lamin A/C disease), and 10 healthy control subjects before and during an oral glucose tolerance test by indirect calorimetry and im microdialysis. Muscle biopsies were taken for in vitro studies. RESULTS We observed marked increased skeletal muscle fatty acid beta-oxidation rate in vitro and in vivo, even after glucose ingestion in FPLD patients. However, fatty acid oxidation was largely incomplete and accompanied by increased ketogenesis. The lipid oxidation abnormality was associated with impaired glucose disposition through reduction in glucose oxidation, rather than decreased cellular glucose uptake. A microarray showed down-regulation of complex I respiratory chain, glycolysis, and nuclear transport genes. Although not overtly insulin resistant, the LGMD1B patient showed similar metabolic derangements as the FPLD patients. CONCLUSIONS Our study suggests imbalance between lipid oxidation and oxidative glucose metabolism in FPLD and LGMD1B patients. The observation suggests an intrinsic defect in skeletal muscle metabolism due to lamin A/C dysfunction. The metabolic FPLD phenotype likely results from this intrinsic defect combined with lipodystrophic "lipid pressure" due to decreased adipose tissue lipid storage capacity.
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Affiliation(s)
- Michael Boschmann
- Franz-Volhard Clinical Research Center at the Experimental and Clinical Research Center, University Hospital Charite Campus Buch and HELIOS Klinikum-Berlin, 13125 Berlin, Germany.
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Engeli S, Boschmann M, Frings P, Beck L, Janke J, Titze J, Luft FC, Heer M, Jordan J. Influence of salt intake on renin-angiotensin and natriuretic peptide system genes in human adipose tissue. Hypertension 2006; 48:1103-8. [PMID: 17060507 DOI: 10.1161/01.hyp.0000248837.88749.18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We tested the hypothesis that changes in sodium intake modulate adipose-tissue renin-angiotensin and natriuretic peptide system gene expression in humans. We studied 9 healthy young men in a metabolic ward at constant room temperature, humidity, and water, potassium, and calcium intake. Subjects were submitted to 4 different periods of sodium intake, and blood samples, microdialysis samples (interstitial fluid), and biopsies from subcutaneous abdominal adipose tissue were obtained at the end of the low-sodium period (0.7 mmol Na/kg per day) and at the end of the high-sodium period (7.7 mmol Na/kg per day). Urinary sodium excretion was 64+/-4 mmol per day with the low-sodium diet and 521+/-8 mmol per day with the high-sodium diet. Systemic and microdialysate sodium concentrations were similar with both interventions. With high-sodium intake, systemic renin activity and aldosterone levels were suppressed, angiotensin-converting enzyme activity did not change, and systemic levels of the atrial natriuretic peptide increased. High-sodium diet increased angiotensin-converting enzyme and atrial natriuretic peptide gene expression in adipose tissue. None of the other genes tested were influenced by changes in dietary sodium intake. Our findings suggest that the adipose-tissue renin-angiotensin system is not part of a feedback mechanism regulating sodium homeostasis and blood pressure. Systemic and adipose-tissue renin-angiotensin systems are regulated at least in part independently from each other. In contrast, systemic atrial natriuretic peptide and adipose-tissue atrial natriuretic peptide respond similarly to changes in sodium intake.
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Affiliation(s)
- Stefan Engeli
- Franz Volhard Clinical Research Center, Medical Faculty of the Charité and Helios Klinikum, Berlin, Germany
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12
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Janke J, Schupp M, Engeli S, Gorzelniak K, Boschmann M, Sauma L, Nystrom FH, Jordan J, Luft FC, Sharma AM. Angiotensin type 1 receptor antagonists induce human in-vitro adipogenesis through peroxisome proliferator-activated receptor-γ activation. J Hypertens 2006; 24:1809-16. [PMID: 16915030 DOI: 10.1097/01.hjh.0000242405.68461.84] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In clonal animal cells, certain angiotensin receptor blockers (ARB) activate the peroxisome proliferator-activated receptor-gamma (PPARgamma). The aim of this work was to validate that observation in human cells and humans. METHODS We investigated the induction of in-vitro adipogenesis and the activation of PPARgamma-target genes, adiponectin and lipoprotein lipase, by ARB in human preadipocytes. We also studied PPARgamma response-element-driven luciferase reporter gene activation in human adipocytes. Finally, we treated 14 obese men for 10 days with placebo crossed over with 150 mg/day irbesartan. Subcutaneous fat was analyzed for mRNA expression of adiponectin and lipoprotein lipase. RESULTS Telmisartan and irbesartan, and to a lesser degree losartan, induced adipogenesis and activated PPARgamma-target genes. This stimulation of PPARgamma-target genes was prevented by the PPARgamma antagonist GW9662. Eprosartan had no effect. Paradoxically, all ARB activated the luciferase reporter gene. PPARgamma activity increased approximately two-fold with pioglitazone and 1.5-fold with the ARB in all assays. In the cross-over clinical study, irbesartan lowered blood pressure but had no effect on adiponectin or lipoprotein lipase mRNA expression. CONCLUSIONS Our data are the first to show that ARB induce adipogenesis and PPARgamma-target gene expression in human adipocytes. Pharmacokinetic differences may contribute to the heterogeneous effects on metabolism and preadipocyte differentiation. In humans, larger doses of ARB, longer treatments, or both may be required to activate PPARgamma in adipose cells.
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Affiliation(s)
- Jürgen Janke
- Medical Faculty of the Charité, Franz Volhard Clinic, HELIOS Klinikum-Berlin, Berlin, Germany.
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Boschmann M, Adams F, Schaller K, Franke G, Sharma AM, Klaus S, Luft FC, Jordan J. Hemodynamic and metabolic responses to interstitial angiotensin II in normal weight and obese men. J Hypertens 2006; 24:1165-71. [PMID: 16685217 DOI: 10.1097/01.hjh.0000226207.11184.5f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The expression of the AT1 receptor in adipose tissue is not decreased or even increased in obese subjects despite systemic activation of the renin-angiotensin system. Therefore, we hypothesized that peripheral tissues of obese subjects are hypersensitive to angiotensin (Ang) II. METHODS We characterized the effect of locally applied Ang II in skeletal muscle and subcutaneous adipose tissue of healthy non-obese (n = 12) and obese (n = 11) men using the microdialysis technique. Tissues were perfused with Ringer's solution + ethanol and incremental doses of Ang II (0.01, 0.1 and 1 micromol/l). Dialysate ethanol, glycerol, glucose, lactate, and pyruvate concentrations were measured to assess changes in blood flow (ethanol dilution technique), lipolysis and glycolysis, respectively. RESULTS In adipose tissue, basal ethanol ratio was significantly higher and dialysate metabolite concentrations were significantly lower in obese versus non-obese men. In muscle, basal dialysate glycerol was significantly higher in obese versus non-obese men. Ang II elicited small increases in ethanol ratio and decreases in dialysate glucose in adipose tissue and skeletal muscle in both non-obese and obese men. Dialysate lactate increased significantly in both tissues of obese, but not non-obese men. Dialysate glycerol increased in adipose tissue of non-obese (+ 40%) but not of obese and remained almost unchanged in muscle of both groups. CONCLUSIONS Interstitially applied Ang II elicits subtle changes in tissue perfusion and metabolism. However, we did not find a major increase in interstitial Ang II responsiveness in obese men.
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Affiliation(s)
- Michael Boschmann
- Franz Volhard Clinical Research Center, Charité, Universitary Medicine Berlin, Germany.
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Jordan J, Engeli S, Boschmann M, Weidinger G, Luft FC, Sharma AM, Kreuzberg U. Hemodynamic and metabolic responses to valsartan and atenolol in obese hypertensive patients. J Hypertens 2006; 23:2313-8. [PMID: 16269974 DOI: 10.1097/01.hjh.0000188734.98463.82] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE None of the current hypertension guidelines provides specific guidance regarding pharmacological management of obese hypertensive patients. Treatment recommendations for lean hypertensives may not be simply extrapolated to obese hypertensive persons. DESIGN Randomized, double-blind, parallel-group study with a 13-week treatment period. SETTING Multicenter study in Germany. PATIENTS Obese patients with mild to moderate uncomplicated essential hypertension. INTERVENTION Patients were treated with valsartan at a maximal dose of 160 mg/day or with atenolol at a maximal dose of 100 mg/day. Hydrochlorothiazide at doses of 12.5-25 mg was added in patients with blood pressure > 140/90 mmHg on monotherapy. MAIN OUTCOME MEASURES Blood pressure, lipid and glucose metabolism, and highly sensitive C-reactive protein (hsCRP) were monitored. RESULTS Sixty-seven patients were randomized to valsartan and 65 patients to atenolol. With valsartan, systolic blood pressure (SBP) decreased from 160.8 +/- 8.9 to 140.5 +/- 13.3 mmHg and diastolic blood pressure (DBP) from 96.1 +/- 7.0 to 85.1 +/- 8.1 mmHg by the end of the study. With atenolol, SBP decreased from 159.3 +/- 6.8 to 139.8 +/- 14.5 mmHg and DBP from 95.0 +/- 6.8 to 83.5 +/- 7.5 mmHg (P = 0.91 for SBP and P = 0.34 for DBP between interventions). Body weight did not change with either treatment. We did not see a significant difference in the response of lipid levels or hsCRP between interventions. To assess the cumulative effect of each intervention on glucose metabolism over the trial duration, we calculated individual areas under the curve for homeostasis model assessment for insulin resistance (HOMA-IR) over time. The resulting area under the curve was significantly smaller with valsartan compared with atenolol (P = 0.02). CONCLUSIONS Beta-adrenoreceptor blockers and AT1-receptor blockers, particularly in combination with low-dose diuretics, effectively lower blood pressure in obese hypertensives. However, metabolic responses differ between both treatment strategies, with beneficial effects of AT1-receptor blockers. AT1-receptor blockers are a good choice in obese hypertensives, given the profoundly increased diabetes risk in this population.
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Affiliation(s)
- Jens Jordan
- Franz-Volhard Clinical Research Center, Medical Faculty of the Charité and Helios Klinikum, Berlin, Germany.
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15
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Abstract
The renin-angiotensin-aldosterone system (RAAS) is a key regulator of cardiovascular function. RAAS activity is upregulated in obesity despite concurrent renal sodium retention, which is a hallmark and principle determinant of obesity-associated hypertension. The contribution of adipose tissue to increased angiotensinogen and aldosterone plasma levels in obesity is probably due to the secretion of angiotensinogen and, as yet, unidentified aldosterone secretagogues by adipocytes. Increased circulating renin activity, on the other hand, is probably due to increased sympathetic activity in the obese. Modest weight reduction significantly reduces RAAS activity by uncertain mechanisms. Pharmacological blockade of the RAAS yielded promising results, both with regard to cardiovascular function and metabolic complications of obesity. These studies suggest that the activated RAAS is a prime pharmacological target for reducing the cardiometabolic risk in obese patients.
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Affiliation(s)
- Arya M Sharma
- b Professor of Medicine, Canada Research Chair for Cardiovascular Obesity Research and Management, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2 .
| | - Stefan Engeli
- a Franz-Volhard-Zentrum für Klinische Forschung (Haus 129), Charité Campus Buch, Wiltbergstr. 50, 13125 Berlin, Germany.
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Boschmann M, Engeli S, Adams F, Franke G, Luft FC, Sharma AM, Jordan J. Influences of AT1 receptor blockade on tissue metabolism in obese men. Am J Physiol Regul Integr Comp Physiol 2006; 290:R219-23. [PMID: 16109807 DOI: 10.1152/ajpregu.00341.2005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ANG II applied to the interstitial space influences carbohydrate and lipid metabolism in a tissue-specific fashion. Thus endogenous ANG II may have a tonic effect on tissue metabolism that could be reversed with ANG II type 1 (AT1) receptor blockade, particularly during adrenergic stimulation. We studied 14 obese men. They were treated for 10 days with the AT1 receptor blocker irbesartan or with placebo in a double-blind and crossover fashion. At the end of each treatment period, we assessed skeletal muscle and adipose tissue metabolism using the microdialysis technique. The ethanol dilution technique was applied to follow changes in tissue blood flow. Measurements were obtained at baseline and during application of incremental isoproterenol concentrations through the microdialysis catheter. Blood pressure decreased from 133 ± 3/84 ± 3 to 128 ± 3/79 ± 2 mmHg for systolic and diastolic blood, respectively ( P = 0.02 and 0.006, respectively) with AT1 receptor blockade. Isoproterenol perfusion caused a dose-dependent increase in dialysate glycerol in adipose tissue and in skeletal muscle. Irbesartan slightly reduced the isoproterenol-induced glycerol response in adipose tissue ( P < 0.05 by ANOVA). Ethanol ratio, interstitial glucose supply, and lactate production in adipose tissue and skeletal muscle were similar with placebo and irbesartan. We conclude that AT1 receptor blockade in obese men does not reveal a major tonic ANG II effect on interstitial glucose supply, lipolysis, or glycolysis in skeletal muscle, either at rest or during β-adrenergic stimulation. Endogeneous ANG II may slightly increase adipose tissue lipolysis. The mechanism may promote the redistribution of triglycerides from adipose tissue toward other organs.
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Affiliation(s)
- Michael Boschmann
- Franz Volhard Clinical Research Center, Haus 129, Charité Campus Buch, Wiltbergstr. 50, 13125 Berlin, Germany
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Cabassi A, Coghi P, Govoni P, Barouhiel E, Speroni E, Cavazzini S, Cantoni AM, Scandroglio R, Fiaccadori E. Sympathetic modulation by carvedilol and losartan reduces angiotensin II-mediated lipolysis in subcutaneous and visceral fat. J Clin Endocrinol Metab 2005; 90:2888-97. [PMID: 15741261 DOI: 10.1210/jc.2004-1995] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Advanced heart failure is characterized by increased activation of the renin-angiotensin system and the development of cachexia. Angiotensin II (Ang II) has been proposed as a lipid metabolism regulator. The effects of exogenous Ang II (osmotic minipump, 525 ng/kg/min for 12 d) on interstitial sc glycerol and norepinephrine levels, indexes of lipolysis, and sympathetic activation, respectively, were measured in Sprague Dawley rats by consecutive microdialysis performed in vivo in white adipose tissue. Higher sustained interstitial glycerol and norepinephrine levels were found after 7 and 12 d of Ang II infusion. Triglyceride to DNA content ratio and adipocyte diameter were reduced in sc and visceral (retroperitoneal and epididymal) fat tissues of Ang II-infused rats, whose body weight was lower and blood pressure higher. Losartan, an Ang II receptor 1 blocker, and carvedilol, an alpha1-nonselective-beta1,2,3-adrenergic blocker, but not doxazosin, an alpha1-selective-adrenergic blocker, lowered glycerol and norepinephrine levels, preventing lipolysis and weight loss. Our results indicate that Ang II stimulates lipolysis in sc and visceral adipocytes by sympathetic activation and beta-adrenergic-receptor stimulation. Nonselective-beta-adrenergic and Ang II-receptor1 blockade markedly attenuated the rise of norepinephrine, preventing catabolic effects. The metabolic benefits of carvedilol and losartan, in addition to recognized protective cardiovascular effects, may be relevant in cachectic patients with advanced heart failure.
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Affiliation(s)
- Aderville Cabassi
- Laboratory of Clinical Physiology, Hypertension Unit, Department of Internal Medicine, Nephrology, and Health Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy.
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Engeli S, Böhnke J, Gorzelniak K, Janke J, Schling P, Bader M, Luft FC, Sharma AM. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005; 45:356-62. [PMID: 15630041 DOI: 10.1161/01.hyp.0000154361.47683.d3] [Citation(s) in RCA: 442] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The renin-angiotensin-aldosterone system has been causally implicated in obesity-associated hypertension. We studied the influence of obesity and weight reduction on the circulating and adipose tissue renin-angiotensin-aldosterone system in menopausal women. Blood samples were analyzed for angiotensinogen, renin, aldosterone, angiotensin-converting enzyme activity, and angiotensin II. In adipose tissue biopsy samples, we analyzed angiotensinogen, renin, renin-receptor, angiotensin-converting enzyme, and angiotensin II type-1 receptor gene expression. Obese women (n=19) had higher circulating angiotensinogen, renin, aldosterone, and angiotensin-converting enzyme than lean women (n=19), and lower angiotensinogen gene expression in adipose tissue. Seventeen women successfully participated in a weight reduction protocol over 13 weeks to reduce daily caloric intake by 600 kcal. Body weight was reduced by -5%, as were angiotensinogen levels by -27%, renin by -43%, aldosterone by -31%, angiotensin-converting enzyme activity by -12%, and angiotensinogen expression by -20% in adipose tissue (all P<0.05). The plasma angiotensinogen decrease was highly correlated with the waist circumference decline (r=0.74; P<0.001). Weight and renin-angiotensin-aldosterone system reductions were accompanied by a -7-mm Hg reduced systolic ambulatory blood pressure. These data suggest that a 5% reduction in body weight can lead to a meaningfully reduced renin-angiotensin-aldosterone system in plasma and adipose tissue, which may contribute to the reduced blood pressure.
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Affiliation(s)
- Stefan Engeli
- Medical Faculty of the Charité, Franz Volhard Clinic and Max Delbrück Center for Molecular Medicine, HELIOS-Klinikum, Berlin, Germany.
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Engeli S, Janke J, Gorzelniak K, Böhnke J, Ghose N, Lindschau C, Luft FC, Sharma AM. Regulation of the nitric oxide system in human adipose tissue. J Lipid Res 2004; 45:1640-8. [PMID: 15231849 DOI: 10.1194/jlr.m300322-jlr200] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nitric oxide (NO) is involved in adipose tissue biology by influencing adipogenesis, insulin-stimulated glucose uptake, and lipolysis. The enzymes responsible for NO formation in adipose cells are endothelial NO synthase (eNOS) and inducible NO synthase (iNOS), whereas neuronal NO synthase (bNOS) is not expressed in adipocytes. We characterized the expression pattern and the influence of adipogenesis, obesity, and weight loss on genes belonging to the NO system in human subcutaneous adipose cells by combining in vivo and in vitro studies. Expression of most of the genes known to belong to the NO system (eNOS, iNOS, subunits of the soluble guanylate cyclase, and both genes encoding cGMP-dependent protein kinases) in human adipose tissue and isolated human adipocytes was detected. In vitro adipogenic differentiation increased the expression level of iNOS significantly, whereas eNOS expression levels were not influenced. The genes encoding eNOS, iNOS, and cGMP-dependent protein kinase 1 were expressed at higher levels in obese women. Expression of these genes, however, was not influenced by 5% weight loss. Insulin and angiotensin II (Ang II) increased NO production by human preadipocytes in vitro. Increased eNOS and iNOS expression in adipocytes and local effects of insulin and Ang II may increase adipose tissue production of NO in obesity.
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Affiliation(s)
- Stefan Engeli
- HELIOS-Klinikum Berlin, Franz Volhard Clinic, Charite University Medicine in Berlin, Max Delbruck Center for Molecular Medicine, Berlin, Germany.
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Abstract
Obesity, currently affecting >20% of the adult population in most Western countries, is a major risk factor for the development of hypertension. Hypertension in obese patients is, in the majority of instances, further complicated by the concomitant presence of dyslipidemia and insulin resistance. The latter is reflected by derangement of glucose homeostasis, ranging from hyperinsulinemia to frank type 2 diabetes. Hypertension in obese patients is also associated with an increased risk for left ventricular hypertrophy, endothelial dysfunction, renal hyperfiltration, microalbuminuria, and elevated markers of inflammation. Sodium retention, volume expansion, and increased cardiac output are common findings in obese individuals. These changes are largely attributable to increased activity of the sympathetic nervous system and insufficient suppression of the renin-angiotensin system. Recent data show increased expression of angiotensin II-forming enzymes in adipose tissue, and increased activity of the renin-angiotensin system has recently been implicated in the development of insulin resistance and type 2 diabetes. Accordingly, antihypertensive agents that block the renin-angiotensin system might be a beneficial strategy for treatment of obesity-related hypertension. Both angiotensin-converting enzyme inhibitors and angiotensin type-1 receptor blockers have been associated with favorable metabolic properties and end-organ protection in addition to their antihypertensive effects. Data from ongoing large trials will provide an indication of the protective and preventive effects of these treatment strategies while offering insights into the mechanisms linking obesity, hypertension, and other facets of the metabolic syndrome.
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Affiliation(s)
- Arya M Sharma
- McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, Canada.
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Schroeder C, Adams F, Boschmann M, Tank J, Haertter S, Diedrich A, Biaggioni I, Luft FC, Jordan J. Phenotypical evidence for a gender difference in cardiac norepinephrine transporter function. Am J Physiol Regul Integr Comp Physiol 2004; 286:R851-6. [PMID: 14726430 DOI: 10.1152/ajpregu.00689.2003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Norepinephrine transporter (NET) function has a central role in the regulation of synaptic norepinephrine concentrations. Clinical observations in orthostatic intolerance patients suggest a gender difference in NET function. We compared the cardiovascular response to selective NET inhibition with reboxetine between 12 healthy men and 12 age-matched women. Finger blood pressure, brachial blood pressure, and heart rate were measured. The subjects underwent cardiovascular autonomic reflex testing and a graded head-up tilt test. In a separate study, we applied incremental concentrations of tyramine and isoproterenol through subcutaneous microdialysis catheters in eight men and in eight women. NET inhibition elicited a threefold greater increase in supine blood pressure in men than women (P < 0.05). The pressor response was driven by an increased cardiac output. The orthostatic heart rate increase during NET inhibition was greater in men than women (56 +/- 5 beats/min in men, 42 +/- 4 beats/min in women, P < 0.001). In contrast, NET inhibition resulted in a similar suppression in the cold pressor and handgrip response, low-frequency blood pressure oscillations, and venous norepinephrine in the supine position. Men and women were similarly sensitive to the lipolytic effect of isoproterenol and tyramine. We conclude that NET inhibition results in more pronounced changes in cardiac regulation in men than women. Our observations suggest that the NET contribution to cardiac norepinephrine turnover may be decreased in women. The gender difference in NET function may not be expressed in tissues that are less NET dependent than the heart.
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Affiliation(s)
- Christoph Schroeder
- Franz Volhard Clinical Research Center, Haus 129, Medical Faculty of the Charité-Campus Buch, Wiltbergstrasse 50, 13125 Berlin, Germany
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