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Glucocorticoids: Fuelling the Fire of Atherosclerosis or Therapeutic Extinguishers? Int J Mol Sci 2021; 22:ijms22147622. [PMID: 34299240 PMCID: PMC8303333 DOI: 10.3390/ijms22147622] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/21/2023] Open
Abstract
Glucocorticoids are steroid hormones with key roles in the regulation of many physiological systems including energy homeostasis and immunity. However, chronic glucocorticoid excess, highlighted in Cushing's syndrome, is established as being associated with increased cardiovascular disease (CVD) risk. Atherosclerosis is the major cause of CVD, leading to complications including coronary artery disease, myocardial infarction and heart failure. While the associations between glucocorticoid excess and increased prevalence of these complications are well established, the mechanisms underlying the role of glucocorticoids in development of atheroma are unclear. This review aims to better understand the importance of glucocorticoids in atherosclerosis and to dissect their cell-specific effects on key processes (e.g., contractility, remodelling and lesion development). Clinical and pre-clinical studies have shown both athero-protective and pro-atherogenic responses to glucocorticoids, effects dependent upon their multifactorial actions. Evidence indicates regulation of glucocorticoid bioavailability at the vasculature is complex, with local delivery, pre-receptor metabolism, and receptor expression contributing to responses linked to vascular remodelling and inflammation. Further investigations are required to clarify the mechanisms through which endogenous, local glucocorticoid action and systemic glucocorticoid treatment promote/inhibit atherosclerosis. This will provide greater insights into the potential benefit of glucocorticoid targeted approaches in the treatment of cardiovascular disease.
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2
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Gilyarevskiy SR, Bendeliani NG, Golshmid MV, Kuzmina IM. New Clinical Aspects of Eplerenone Use in Clinical Practice. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-4-612-620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The problem of the discrepancy between convincing evidences of the effectiveness of the use of mineralocorticoid receptor antagonists in patients with heart failure with reduced left ventricular ejection fraction and insufficiently frequent their use in clinical practice for the treatment of these patients is considered in the article. Experts opinions on the reasons for this discrepancy are also presented. New data on the effectiveness of the use of the mineralocorticoid receptor antagonist, eplerenone, in some clinical situations identified in the analysis of subgroups of participants in a large randomized clinical trial EMPHASIS-HF are discussed. The main goal of this study was to evaluate the efficacy of eplerenone compared with placebo in patients with heart failure and reduced left ventricular function. In addition, experimental animal studies, which may indicate the pleiotropic effects of eplerenone in patients with vascular diseases, are presented. The new data on the effectiveness of eplerenone in subgroups of patients with heart failure and certain characteristics may be an additional reason to draw the attention of physicians to the benefits of its use and, accordingly, its more frequent application in clinical practice for the treatment of patients with clear indications for this therapy.
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Dutzmann J, Bauersachs J, Sedding DG. Evidence for the use of mineralocorticoid receptor antagonists in the treatment of coronary artery disease and post-angioplasty restenosis. Vascul Pharmacol 2017; 107:S1537-1891(17)30281-1. [PMID: 29274772 DOI: 10.1016/j.vph.2017.12.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/05/2017] [Accepted: 12/19/2017] [Indexed: 12/14/2022]
Abstract
Mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone have an established role in the treatment of heart failure. However, many experimental and clinical studies have shown that aldosterone also plays a pivotal role in a variety of other pathophysiological conditions within the cardiovascular system. Aldosterone has been suggested to promote inflammation, endothelial dysfunction and smooth muscle cell hyperplasia during the development of atherosclerosis, thereby promoting the development of coronary artery disease (CAD). Since CAD and subsequent ischemic cardiomyopathy are the major causes of heart failure, it is of major interest, whether pharmacological therapy with MRAs among heart failure patients will also affect the common underlying conditions, namely, atherosclerosis and subsequent coronary vessel narrowing/rarefication. Therefore, in this article, we reviewed and discussed the preclinical and clinical evidence of MRAs for the treatment of acute or chronic vascular remodeling processes, such as atherosclerosis and post-angioplasty restenosis, which determine the progression of CAD and subsequent ischemic cardiomyopathy.
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Affiliation(s)
- Jochen Dutzmann
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Daniel G Sedding
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Nehme A, Zibara K. Cellular distribution and interaction between extended renin-angiotensin-aldosterone system pathways in atheroma. Atherosclerosis 2017; 263:334-342. [PMID: 28600074 DOI: 10.1016/j.atherosclerosis.2017.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/14/2017] [Accepted: 05/24/2017] [Indexed: 01/06/2023]
Abstract
The importance of the renin-angiotensin-aldosterone system (RAAS) in the development of atherosclerotic has been experimentally documented. In fact, RAAS components have been shown to be locally expressed in the arterial wall and to be differentially regulated during atherosclerotic lesion progression. RAAS transcripts and proteins were shown to be differentially expressed and to interact in the 3 main cells of atheroma: endothelial cells, vascular smooth muscle cells, and macrophages. This review describes the local expression and cellular distribution of extended RAAS components in the arterial wall and their differential regulation during atherosclerotic lesion development.
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Affiliation(s)
- Ali Nehme
- EA4173, Functional Genomics of Arterial Hypertension, Hôpital Nord-Ouest, Villefranche-sur-Saône, Université Lyon1, Lyon, France; ER045, Laboratory of Stem Cells, Department of Biology, Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Kazem Zibara
- ER045, Laboratory of Stem Cells, Department of Biology, Faculty of Sciences, Lebanese University, Beirut, Lebanon.
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5
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Nehme A, Cerutti C, Zibara K. Transcriptomic Analysis Reveals Novel Transcription Factors Associated With Renin-Angiotensin-Aldosterone System in Human Atheroma. Hypertension 2016; 68:1375-1384. [PMID: 27754866 DOI: 10.1161/hypertensionaha.116.08070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/16/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
Despite the well-known role of the renin-angiotensin-aldosterone system (RAAS) in atheroma, its global local organization is poorly understood. In this study, we used transcriptomic meta-analysis to reveal the local transcriptional organization and regulation of 37 extended RAAS (extRAAS) genes in atheroma. Expression analysis and hierarchical clustering were done on extRAAS genes in 32 paired early and advanced atherosclerotic lesions. Contrary to receptor-coding transcripts, multiple angiotensin-metabolizing enzymes showed higher expression in advance, in comparison to early lesions. Interestingly, similar results were obtained from GEO data sets containing human (n=839) and mouse (n=18) atherosclerotic samples, but different from normal human (n=11) arterial tissues. The expression and coordination patterns were then used to construct transcriptional maps of extRAAS, displaying favored pathways in atheroma. Three coexpression modules (M1, M2, and M3) with >80% reproducibility across human atheroma data sets were identified. M1 and M3 contained angiotensin-metabolizing enzymes transcripts, whereas M2 contained proatherogenic receptor-coding transcripts. Interestingly, M1 and M2 were negatively correlated. A total of 21 transcription factors with enriched binding sites in the promoters of coordinated genes were extracted, among which IRF5, MAX, and ETV5 showed significant positive correlations with M1, but negative correlations with M2. However, ETS1 and SMAD1 transcripts were positively correlated to receptor-coding genes in M2. Despite sharing some similarities in extRAAS organization with kidney and adipose, atheroma showed specific correlations between extRAAS and transcription factors. In conclusion, our transcriptional map helps in designing more efficient treatments for atherosclerosis. In addition, the identified transcription factors provide a basis for the discovery of atheroma-specific modulators of extRAAS.
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Affiliation(s)
- Ali Nehme
- From the EA4173, Functional Genomics of Arterial Hypertension, UCBL-1, Lyon, France (A.N., C.C.); and ER045, Laboratory of Stem Cells, DSST (A.N., K.Z.) and Department of Biology, Faculty of Sciences-I (K.Z.), Lebanese University, Beirut, Lebanon
| | - Catherine Cerutti
- From the EA4173, Functional Genomics of Arterial Hypertension, UCBL-1, Lyon, France (A.N., C.C.); and ER045, Laboratory of Stem Cells, DSST (A.N., K.Z.) and Department of Biology, Faculty of Sciences-I (K.Z.), Lebanese University, Beirut, Lebanon
| | - Kazem Zibara
- From the EA4173, Functional Genomics of Arterial Hypertension, UCBL-1, Lyon, France (A.N., C.C.); and ER045, Laboratory of Stem Cells, DSST (A.N., K.Z.) and Department of Biology, Faculty of Sciences-I (K.Z.), Lebanese University, Beirut, Lebanon.
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6
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Suchacki KJ, Cawthorn WP, Rosen CJ. Bone marrow adipose tissue: formation, function and regulation. Curr Opin Pharmacol 2016; 28:50-6. [PMID: 27022859 DOI: 10.1016/j.coph.2016.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
Abstract
The human body requires an uninterrupted supply of energy to maintain metabolic homeostasis and energy balance. To sustain energy balance, excess consumed calories are stored as glycogen, triglycerides and protein, allowing the body to continue to function in states of starvation and increased energy expenditure. Adipose tissue provides the largest natural store of excess calories as triglycerides and plays an important role as an endocrine organ in energy homeostasis and beyond. This short review is intended to detail the current knowledge of the formation and role of bone marrow adipose tissue (MAT), a largely ignored adipose depot, focussing on the role of MAT as an endocrine organ and highlighting the pharmacological agents that regulate MAT.
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Affiliation(s)
- Karla J Suchacki
- The Queen's Medical Research Institute, University of Edinburgh, UK.
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7
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White CI, Jansen MA, McGregor K, Mylonas KJ, Richardson RV, Thomson A, Moran CM, Seckl JR, Walker BR, Chapman KE, Gray GA. Cardiomyocyte and Vascular Smooth Muscle-Independent 11β-Hydroxysteroid Dehydrogenase 1 Amplifies Infarct Expansion, Hypertrophy, and the Development of Heart Failure After Myocardial Infarction in Male Mice. Endocrinology 2016; 157:346-57. [PMID: 26465199 PMCID: PMC4701896 DOI: 10.1210/en.2015-1630] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Global deficiency of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), an enzyme that regenerates glucocorticoids within cells, promotes angiogenesis, and reduces acute infarct expansion after myocardial infarction (MI), suggesting that 11β-HSD1 activity has an adverse influence on wound healing in the heart after MI. The present study investigated whether 11β-HSD1 deficiency could prevent the development of heart failure after MI and examined whether 11β-HSD1 deficiency in cardiomyocytes and vascular smooth muscle cells confers this protection. Male mice with global deficiency in 11β-HSD1, or with Hsd11b1 disruption in cardiac and vascular smooth muscle (via SM22α-Cre recombinase), underwent coronary artery ligation for induction of MI. Acute injury was equivalent in all groups. However, by 8 weeks after induction of MI, relative to C57Bl/6 wild type, globally 11β-HSD1-deficient mice had reduced infarct size (34.7 ± 2.1% left ventricle [LV] vs 44.0 ± 3.3% LV, P = .02), improved function (ejection fraction, 33.5 ± 2.5% vs 24.7 ± 2.5%, P = .03) and reduced ventricular dilation (LV end-diastolic volume, 0.17 ± 0.01 vs 0.21 ± 0.01 mL, P = .01). This was accompanied by a reduction in hypertrophy, pulmonary edema, and in the expression of genes encoding atrial natriuretic peptide and β-myosin heavy chain. None of these outcomes, nor promotion of periinfarct angiogenesis during infarct repair, were recapitulated when 11β-HSD1 deficiency was restricted to cardiac and vascular smooth muscle. 11β-HSD1 expressed in cells other than cardiomyocytes or vascular smooth muscle limits angiogenesis and promotes infarct expansion with adverse ventricular remodeling after MI. Early pharmacological inhibition of 11β-HSD1 may offer a new therapeutic approach to prevent heart failure associated with ischemic heart disease.
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MESH Headings
- 11-beta-Hydroxysteroid Dehydrogenase Type 1/deficiency
- 11-beta-Hydroxysteroid Dehydrogenase Type 1/genetics
- 11-beta-Hydroxysteroid Dehydrogenase Type 1/metabolism
- Animals
- Cardiomegaly/etiology
- Cardiomegaly/prevention & control
- Coronary Circulation
- Crosses, Genetic
- Gene Expression Regulation
- Heart Failure/etiology
- Heart Failure/prevention & control
- Heart Ventricles/metabolism
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocardial Infarction/metabolism
- Myocardial Infarction/pathology
- Myocardial Infarction/physiopathology
- Myocytes, Cardiac/enzymology
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Neovascularization, Physiologic
- Organ Size
- Pulmonary Edema/etiology
- Pulmonary Edema/prevention & control
- Stroke Volume
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Affiliation(s)
- Christopher I White
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Maurits A Jansen
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Kieran McGregor
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Katie J Mylonas
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Rachel V Richardson
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Adrian Thomson
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Carmel M Moran
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Jonathan R Seckl
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Brian R Walker
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Karen E Chapman
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Gillian A Gray
- British Heart Foundation/University Centre for Cardiovascular Science (C.I.W., M.A.J., K.M., K.J.M., R.V.R., C.M.M., J.R.S., B.R.W., K.E.C., G.A.G.), Queens Medical Research Institute, and Edinburgh Preclinical Imaging (M.A.J., A.T., C.M.M.), College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH16 4TJ, Scotland, United Kingdom
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Parviz Y, Iqbal J, Pitt B, Adlam D, Al-Mohammad A, Zannad F. Emerging cardiovascular indications of mineralocorticoid receptor antagonists. Trends Endocrinol Metab 2015; 26:201-11. [PMID: 25707577 DOI: 10.1016/j.tem.2015.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/24/2015] [Accepted: 01/27/2015] [Indexed: 01/05/2023]
Abstract
Mineralocorticoid receptor (MR) antagonism is a well-established treatment modality for patients with hypertension, heart failure, and left ventricular systolic dysfunction (LVSD) post-myocardial infarction (MI). There are emerging data showing potential benefits of MR antagonists in other cardiovascular conditions. Studies have shown association between MR activation and the development of myocardial fibrosis, coronary artery disease, metabolic syndrome, and cerebrovascular diseases. This review examines the preclinical and clinical data of MR antagonists for novel indications including heart failure with preserved ejection fraction (HFPEF), pulmonary arterial hypertension (PAH), arrhythmia, sudden cardiac death, valvular heart disease, metabolic syndrome, renal disease, and stroke. MR antagonists are not licensed for these conditions yet; however, emerging data suggest that indication for MR antagonists are likely to broaden; further studies are warranted.
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MESH Headings
- Animals
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/prevention & control
- Cardiovascular Agents/therapeutic use
- Cardiovascular Diseases/drug therapy
- Cardiovascular Diseases/metabolism
- Cardiovascular Diseases/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Disease Progression
- Heart Failure/etiology
- Heart Failure/prevention & control
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/prevention & control
- Mineralocorticoid Receptor Antagonists/therapeutic use
- Models, Biological
- Off-Label Use
- Receptors, Mineralocorticoid/agonists
- Receptors, Mineralocorticoid/chemistry
- Receptors, Mineralocorticoid/metabolism
- Severity of Illness Index
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Affiliation(s)
- Yasir Parviz
- Sheffield Teaching Hospitals, National Health Service (NHS) Trust, Sheffield, UK
| | - Javaid Iqbal
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK.
| | - Bertram Pitt
- Cardiovascular Centre, University of Michigan, Ann Arbor, MI 48109, USA
| | - David Adlam
- Department of Cardiology and National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Abdallah Al-Mohammad
- Sheffield Teaching Hospitals, National Health Service (NHS) Trust, Sheffield, UK
| | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique and Centre Hospitalier Universitaire and the Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France
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9
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Anderson A, Walker BR. 11β-HSD1 inhibitors for the treatment of type 2 diabetes and cardiovascular disease. Drugs 2014; 73:1385-93. [PMID: 23990334 DOI: 10.1007/s40265-013-0112-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Inhibition of the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) has been proposed as a novel therapeutic target for the treatment of type 2 diabetes mellitus. Over 170 new compounds targeting 11β-HSD1 have been developed. This article reviews the current published literature on compounds that have reached phase II clinical trials in patients with type 2 diabetes, and summarises the preclinical evidence that such agents may be useful for associated conditions, including peripheral vascular disease, coronary artery disease and cognitive decline. In clinical trials, 11β-HSD1 inhibitors have been well tolerated and have improved glycaemic control, lipid profile and blood pressure, and induced modest weight loss. The magnitude of the effects are small relative to other agents, so that further development of 11β-HSD1 inhibitors for the primary therapeutic indication of type 2 diabetes has stalled. Ongoing programmes are focused on additional benefits for cognitive function and other cardiovascular risk factors.
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Affiliation(s)
- Anna Anderson
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK
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10
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Iqbal J, Fay R, Adlam D, Squire I, Parviz Y, Gunn J, Pitt B, Zannad F. Effect of eplerenone in percutaneous coronary intervention-treated post-myocardial infarction patients with left ventricular systolic dysfunction: a subanalysis of the EPHESUS trial. Eur J Heart Fail 2014; 16:685-91. [DOI: 10.1002/ejhf.88] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/14/2014] [Accepted: 02/21/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Javaid Iqbal
- Department of Cardiovascular Science at the University of Sheffield, and Cardiology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Renaud Fay
- INSERM, Centre d'Investigation Clinique and Centre Hospitalier Universitaire, and the Department of Cardiology; Nancy University, Université de Lorraine; Nancy France
| | - David Adlam
- Department of Cardiology, and NIHR Cardiovascular Biomedical Research Unit; Glenfield Hospital; Leicester UK
| | - Iain Squire
- Department of Cardiology, and NIHR Cardiovascular Biomedical Research Unit; Glenfield Hospital; Leicester UK
| | - Yasir Parviz
- Department of Cardiovascular Science at the University of Sheffield, and Cardiology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Julian Gunn
- Department of Cardiovascular Science at the University of Sheffield, and Cardiology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Bertram Pitt
- Cardiovascular Centre; University of Michigan; Ann Arbor MI USA
| | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique and Centre Hospitalier Universitaire, and the Department of Cardiology; Nancy University, Université de Lorraine; Nancy France
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11
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Iqbal J, Parviz Y, Pitt B, Newell-Price J, Al-Mohammad A, Zannad F. Selection of a mineralocorticoid receptor antagonist for patients with hypertension or heart failure. Eur J Heart Fail 2013; 16:143-50. [DOI: 10.1111/ejhf.31] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/15/2013] [Accepted: 07/19/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Javaid Iqbal
- Department of Cardiovascular Science at the University of Sheffield and Cardiology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Yasir Parviz
- Department of Cardiovascular Science at the University of Sheffield and Cardiology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Bertram Pitt
- Cardiovascular Centre; University of Michigan; Ann Arbor MI USA
| | - John Newell-Price
- Department of Human Metabolism at the University of Sheffield and Endocrinology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Abdallah Al-Mohammad
- Department of Cardiovascular Science at the University of Sheffield and Cardiology Department at Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique and Centre Hospitalier Universitaire, and the Department of Cardiology; Nancy University, Université de Lorraine; Nancy France
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12
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Harno E, Cottrell EC, Yu A, DeSchoolmeester J, Gutierrez PM, Denn M, Swales JG, Goldberg FW, Bohlooly-Y M, Andersén H, Wild MJ, Turnbull AV, Leighton B, White A. 11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) inhibitors still improve metabolic phenotype in male 11β-HSD1 knockout mice suggesting off-target mechanisms. Endocrinology 2013; 154:4580-93. [PMID: 24169553 PMCID: PMC4192288 DOI: 10.1210/en.2013-1613] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/11/2013] [Indexed: 12/23/2022]
Abstract
The enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) is a target for novel type 2 diabetes and obesity therapies based on the premise that lowering of tissue glucocorticoids will have positive effects on body weight, glycemic control, and insulin sensitivity. An 11β-HSD1 inhibitor (compound C) inhibited liver 11β-HSD1 by >90% but led to only small improvements in metabolic parameters in high-fat diet (HFD)-fed male C57BL/6J mice. A 4-fold higher concentration produced similar enzyme inhibition but, in addition, reduced body weight (17%), food intake (28%), and glucose (22%). We hypothesized that at the higher doses compound C might be accessing the brain. However, when we developed male brain-specific 11β-HSD1 knockout mice and fed them the HFD, they had body weight and fat pad mass and glucose and insulin responses similar to those of HFD-fed Nestin-Cre controls. We then found that administration of compound C to male global 11β-HSD1 knockout mice elicited improvements in metabolic parameters, suggesting "off-target" mechanisms. Based on the patent literature, we synthesized another 11β-HSD1 inhibitor (MK-0916) from a different chemical series and showed that it too had similar off-target body weight and food intake effects at high doses. In summary, a significant component of the beneficial metabolic effects of these 11β-HSD1 inhibitors occurs via 11β-HSD1-independent pathways, and only limited efficacy is achievable from selective 11β-HSD1 inhibition. These data challenge the concept that inhibition of 11β-HSD1 is likely to produce a "step-change" treatment for diabetes and/or obesity.
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Affiliation(s)
- Erika Harno
- Faculty of Life Sciences and Faculty of Medical and Human Sciences, AV Hill Building, University of Manchester, Manchester, M13 9PT, United Kingdom.
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13
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Weigent DA. Lymphocyte GH-axis hormones in immunity. Cell Immunol 2013; 285:118-32. [PMID: 24177252 DOI: 10.1016/j.cellimm.2013.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
The production and utilization of common ligands and their receptors by cells of the immune and neuroendocrine systems constitutes a biochemical information circuit between and within the immune and neuroendocrine systems. The sharing of ligands and receptors allows the immune system to serve as the sixth sense notifying the nervous system of the presence of foreign entities. Within this framework, it is also clear that immune cell functions can be altered by neuroendocrine hormones and that cells of the immune system have the ability to produce neuroendocrine hormones. This review summarizes a part of this knowledge with particular emphasis on growth hormone (GH). The past two decades have uncovered a lot of detail about the actions of GH, acting through its receptor, at the molecular and cellular level and its influence on the immune system. The production and action of immune cell-derived GH is less well developed although its important role in immunity is also slowly emerging. Here we discuss the production of GH, GH-releasing hormone (GHRH) and insulin-like growth factor-1 (IGF-1) and their cognate receptors on cells of the immune system and their influence via endocrine/autocrine/paracrine and intracrine pathways on immune function. The intracellular mechanisms of action of immune cell-derived GH are still largely unexplored, and it is anticipated that further work in this particular area will establish an important role for this source of GH in normal physiology and in pathologic situations.
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Affiliation(s)
- Douglas A Weigent
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, 1918 University Blvd., MCLM894, Birmingham, AL 35294-0005, United States.
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Modulation of 11β-hydroxysteroid dehydrogenase as a strategy to reduce vascular inflammation. Curr Atheroscler Rep 2013; 15:320. [PMID: 23512604 PMCID: PMC3631116 DOI: 10.1007/s11883-013-0320-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atherosclerosis is a chronic inflammatory disease in which initial vascular damage leads to extensive macrophage and lymphocyte infiltration. Although acutely glucocorticoids suppress inflammation, chronic glucocorticoid excess worsens atherosclerosis, possibly by exacerbating systemic cardiovascular risk factors. However, glucocorticoid action within the lesion may reduce neointimal proliferation and inflammation. Glucocorticoid levels within cells do not necessarily reflect circulating levels due to pre-receptor metabolism by 11β-hydroxysteroid dehydrogenases (11β-HSDs). 11β-HSD2 converts active glucocorticoids into inert 11-keto forms. 11β-HSD1 catalyses the reverse reaction, regenerating active glucocorticoids. 11β-HSD2-deficiency/inhibition causes hypertension, whereas deficiency/inhibition of 11β-HSD1 generates a cardioprotective lipid profile and improves glycemic control. Importantly, 11β-HSD1-deficiency/inhibition is atheroprotective, whereas 11β-HSD2-deficiency accelerates atherosclerosis. These effects are largely independent of systemic risk factors, reflecting modulation of glucocorticoid action and inflammation within the vasculature. Here, we consider whether evidence linking the 11β-HSDs to vascular inflammation suggests these isozymes are potential therapeutic targets in vascular injury and atherosclerosis.
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15
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Smooth muscle cell mineralocorticoid receptors: role in vascular function and contribution to cardiovascular disease. Pflugers Arch 2013; 465:1661-70. [PMID: 23636772 DOI: 10.1007/s00424-013-1282-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/11/2013] [Indexed: 02/07/2023]
Abstract
The mineralocorticoid receptor (MR), a member of the steroid receptor family, regulates blood pressure by mediating the effects of the hormone aldosterone on renal sodium handling. In recent years, it has become clear that MR is expressed in vascular smooth muscle cells (SMCs), and interest has grown in understanding the direct role of SMC MR in regulating vascular function. This interest stems from multiple clinical studies where MR inhibitor treatment reduced the incidence of cardiovascular events and mortality. This review summarizes the most recent advances in our understanding of SMC MR in regulating normal vascular function and in promoting vascular disease. Many new studies suggest a role for SMC MR activation in stimulating vascular contraction and contributing to vessel inflammation, fibrosis, and remodeling. These detrimental vascular effects of MR activation appear to be independent of changes in blood pressure and are synergistic with the presence of endothelial dysfunction or damage. Thus, in humans with underlying cardiovascular disease or cardiovascular risk factors, SMC MR activation may promote hypertension, atherosclerosis, and vascular aging. Further exploration of the molecular mechanisms for the effects of SMC MR activation has the potential to identify novel therapeutic targets to prevent or treat common cardiovascular disorders.
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Iqbal J, Gunn J, Serruys PW. Coronary stents: historical development, current status and future directions. Br Med Bull 2013; 106:193-211. [PMID: 23532779 DOI: 10.1093/bmb/ldt009] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Coronary angioplasty with stenting has revolutionized the treatment of coronary artery disease. This article describes the history of coronary angioplasty and stenting, reviews the contemporary stents and recommendations and highlights the on-going work and potential future directions. SOURCES OF DATA This review examined the data on coronary stents available in PubMed. AREAS OF AGREEMENT Coronary artery stenting is the treatment of choice for patients requiring coronary angioplasty. Stents, and particularly drug-eluting stents, reduce the risk of restenosis, but may be associated with the hazard of late stent thrombosis. Dual anti-platelet treatment is recommended for patients receiving coronary stents. AREAS OF CONTROVERSY The selection of stents for various lesions and patients and the duration of anti-platelet therapy remain debated areas. AREAS TIMELY FOR DEVELOPING RESEARCH There are on-going preclinical and clinical studies to develop better stent platforms, more biocompatible polymers, novel anti-proliferative and anti-platelet drugs, pro-healing stents and bioresorbable scaffolds.
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Affiliation(s)
- Javaid Iqbal
- Thorax Centre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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