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Su Z, Sun JY, Gao M, Sun W, Kong X. Molecular mechanisms and potential therapeutic targets in the pathogenesis of hypertension in visceral adipose tissue induced by a high-fat diet. Front Cardiovasc Med 2024; 11:1380906. [PMID: 38689862 PMCID: PMC11058983 DOI: 10.3389/fcvm.2024.1380906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Background Hypertension (HTN) presents a significant global public health challenge with diverse causative factors. The accumulation of visceral adipose tissue (VAT) due to a high-fat diet (HFD) is an independent risk factor for HTN. While various studies have explored pathogenic mechanisms, a comprehensive understanding of impact of VAT on blood pressure necessitates bioinformatics analysis. Methods Datasets GSE214618 and GSE188336 were acquired from the Gene Expression Omnibus and analyzed to identify shared differentially expressed genes between HFD-VAT and HTN-VAT. Gene Ontology enrichment and protein-protein interaction analyses were conducted, leading to the identification of hub genes. We performed molecular validation of hub genes using RT-qPCR, Western-blotting and immunofluorescence staining. Furthermore, immune infiltration analysis using CIBERSORTx was performed. Results This study indicated that the predominant characteristic of VAT in HTN was related to energy metabolism. The red functional module was enriched in pathways associated with mitochondrial oxidative respiration and ATP metabolism processes. Spp1, Postn, and Gpnmb in VAT were identified as hub genes on the pathogenic mechanism of HTN. Proteins encoded by these hub genes were closely associated with the target organs-specifically, the resistance artery, aorta, and heart tissue. After treatment with empagliflozin, there was a tendency for Spp1, Postn, and Gpnmb to decrease in VAT. Immune infiltration analysis confirmed that inflammation and immune response may not be the main mechanisms by which visceral adiposity contributes to HTN. Conclusions Our study pinpointed the crucial causative factor of HTN in VAT following HFD. Spp1, Postn, and Gpnmb in VAT acted as hub genes that promote elevated blood pressure and can be targets for HTN treatment. These findings contributed to therapeutic strategies and prognostic markers for HTN.
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Affiliation(s)
- Zhenyang Su
- School of Medicine, Southeast University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Min Gao
- Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Xiangqing Kong
- School of Medicine, Southeast University, Nanjing, China
- Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
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AlZaim I, Eid AH, Abd-Elrahman KS, El-Yazbi AF. Adipose Tissue Mitochondrial Dysfunction and Cardiometabolic Diseases: On the Search for Novel Molecular Targets. Biochem Pharmacol 2022; 206:115337. [DOI: 10.1016/j.bcp.2022.115337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
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Inhibition of angiotensin pathway via valsartan reduces tumor growth in models of colorectal cancer. Toxicol Appl Pharmacol 2022; 440:115951. [PMID: 35235860 DOI: 10.1016/j.taap.2022.115951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 01/05/2023]
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Srinivasa S, Thomas TS, Feldpausch MN, Adler GK, Grinspoon SK. Coronary Vasculature and Myocardial Structure in HIV: Physiologic Insights From the Renin-Angiotensin-Aldosterone System. J Clin Endocrinol Metab 2021; 106:3398-3412. [PMID: 33624807 PMCID: PMC8864747 DOI: 10.1210/clinem/dgab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 11/19/2022]
Abstract
The landscape of HIV medicine dramatically changed with the advent of contemporary antiretroviral therapies, which has allowed persons with HIV (PWH) to achieve good virologic control, essentially eliminating HIV-related complications and increasing life expectancy. As PWH are living longer, noncommunicable diseases, such as cardiovascular disease (CVD), have become a leading cause of morbidity and mortality in PWH with rates that are 50% to 100% higher than in well-matched persons without HIV. In this review, we focus on disease of the coronary microvasculature and myocardium in HIV. We highlight a key hormonal system important to cardiovascular endocrinology, the renin-angiotensin-aldosterone system (RAAS), as a potential mediator of inflammatory driven-vascular and myocardial injury and consider RAAS blockade as a physiologically targeted strategy to reduce CVD in HIV.
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Affiliation(s)
- Suman Srinivasa
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Teressa S Thomas
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan N Feldpausch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Correspondence: Steven K. Grinspoon, MD, Metabolism Unit, Massachusetts General Hospital, 55 Fruit Street, 5LON207, Boston, MA 02114, USA. E-mail:
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Role of Obesity, Mesenteric Adipose Tissue, and Adipokines in Inflammatory Bowel Diseases. Biomolecules 2019; 9:biom9120780. [PMID: 31779136 PMCID: PMC6995528 DOI: 10.3390/biom9120780] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel diseases (IBDs) are a group of disorders which include ulcerative colitis and Crohn's disease. Obesity is becoming increasingly more common among patients with inflammatory bowel disease and plays a role in the development and course of the disease. This is especially true in the case of Crohn's disease. The recent results indicate a special role of visceral adipose tissue and particularly mesenteric adipose tissue, also known as "creeping fat", in pathomechanism, leading to intestinal inflammation. The involvement of altered adipocyte function and the deregulated production of adipokines, such as leptin and adiponectin, has been suggested in pathogenesis of IBD. In this review, we discuss the epidemiology and pathophysiology of obesity in IBD, the influence of a Western diet on the course of Crohn's disease and colitis in IBD patients and animal's models, and the potential role of adipokines in these disorders. Since altered body composition, decrease of skeletal muscle mass, and development of pathologically changed mesenteric white adipose tissue are well-known features of IBD and especially of Crohn's disease, we discuss the possible crosstalk between adipokines and myokines released from skeletal muscle during exercise with moderate or forced intensity. The emerging role of microbiota and the antioxidative and anti-inflammatory enzymes such as intestinal alkaline phosphatase is also discussed, in order to open new avenues for the therapy against intestinal perturbations associated with IBD.
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Fan X, Copeland P, Nawras S, Harrington A, Freudenreich O, Goff DC, Henderson DC. Adjunctive telmisartan treatment on body metabolism in clozapine or olanzapine treated patients with schizophrenia: a randomized, double blind, placebo controlled trial. Psychopharmacology (Berl) 2019; 236:1949-1957. [PMID: 30747254 DOI: 10.1007/s00213-019-5181-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/28/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study examined the effect of adjunctive telmisartan on body metabolism in clozapine- or olanzapine-treated patients with schizophrenia. METHOD Each subject had been on stable dose of olanzapine or clozapine for at least 1 month. In a 12-week randomized, double-blind, placebo-controlled study, subjects received either telmisartan (80 mg once per day) or placebo. The homeostasis model of assessment of insulin resistance (HOMA-IR) was calculated based on fasting blood levels of insulin and glucose. Fasting blood levels of triglycerides and cholesterols, as well as serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) were measured. The whole-body dual-energy X-ray absorptiometry (DXA) was used to assess body composition. Lipid particles were assessed using nuclear magnetic resonance (NMR) spectroscopy. All assessments were conducted at baseline and repeated at week 12. RESULTS Fifty-four subjects were randomized and 43 completed the study (22 in the telmisartan group, 21 in the placebo group). There were no significant differences between the two groups in week 12 changes for HOMA-IR or fasting triglycerides (- 0.18 ± 1.24 vs 0.39 ± 1.39, p = 0.181; - 26 ± 76 vs - 10 ± 81 mg/dL, p = 0.679, respectively) (telmisartan vs placebo). Further, there were no significant between group differences in week 12 changes for other fasting lipids, body weight, body mass index, waist circumference, as well as various measures of lipid particles (p's > 0.100). The DXA assessment showed no significant differences between the two groups in week 12 changes for fat mass, lean mass, or total mass (p's > 0.100). CONCLUSION In the present study, adjunctive treatment of telmisartan did not seem to improve body metabolism in schizophrenia patients receiving olanzapine or clozapine. The implications for future studies were discussed. CLINICALTRIALS. GOV IDENTIFIER NCT00981526.
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Affiliation(s)
- Xiaoduo Fan
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, 01605, USA.
| | - Paul Copeland
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Shukair Nawras
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, 01605, USA
| | - Amy Harrington
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, 01605, USA
| | - Oliver Freudenreich
- Schizophrenia Program, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Donald C Goff
- Department of Psychiatry, New York University Medical School and Nathan Kline Institute, New York, NY, USA
| | - David C Henderson
- Department of Psychiatry, Boston University/Boston Medical Center, Boston, MA, USA
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Kalra J, Mangali SB, Bhat A, Dhar I, Udumula MP, Dhar A. Imoxin attenuates high fructose-induced oxidative stress and apoptosis in renal epithelial cells via downregulation of protein kinase R pathway. Fundam Clin Pharmacol 2018; 32:297-305. [DOI: 10.1111/fcp.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/24/2018] [Accepted: 02/05/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Jaspreet Kalra
- Department of Pharmacy; Birla Institute of Technology and Sciences Pilani; Hyderabad Campus, Jawahar Nagar, Shameerpet Hyderabad Andhra Pradesh 500078 India
| | - Suresh Babu Mangali
- Department of Pharmacy; Birla Institute of Technology and Sciences Pilani; Hyderabad Campus, Jawahar Nagar, Shameerpet Hyderabad Andhra Pradesh 500078 India
| | - Audesh Bhat
- Department of Molecular Biology; Central University of Jammu; Jammu Jammu and Kashmir 181143 India
| | - Indu Dhar
- Department of Clinical Sciences; University of Bergen; Bergen 5007 Norway
| | - Mary Priyanka Udumula
- Department of Pharmacy; Birla Institute of Technology and Sciences Pilani; Hyderabad Campus, Jawahar Nagar, Shameerpet Hyderabad Andhra Pradesh 500078 India
| | - Arti Dhar
- Department of Pharmacy; Birla Institute of Technology and Sciences Pilani; Hyderabad Campus, Jawahar Nagar, Shameerpet Hyderabad Andhra Pradesh 500078 India
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Le CN, Hulgan T, Tseng CH, Milne GL, Lake JE. Urine Eicosanoids in the Metabolic Abnormalities, Telmisartan, and HIV Infection (MATH) Trial. PLoS One 2017; 12:e0170515. [PMID: 28118376 PMCID: PMC5261803 DOI: 10.1371/journal.pone.0170515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Arachidonic acid metabolites (eicosanoids) reflect oxidative stress and vascular health and have been associated with anthropometric measures and sex differences in cross-sectional analyses of HIV-infected (HIV+) persons. Telmisartan is an angiotensin receptor blocker and PPAR-γ agonist with potential anti-inflammatory and metabolic benefits. We assessed telmisartan's effects on urine eicosanoids among HIV+ adults with central adiposity on suppressive antiretroviral therapy enrolled in a prospective clinical trial. METHODS Thirty-five HIV+ adults (15 women; 20 men) completed 24 weeks of open-label oral telmisartan 40mg daily. Lumbar computed tomography quantified visceral (VAT) and subcutaneous (SAT) abdominal adipose tissue. Urine F2-isoprostane (F2-IsoP), prostaglandin E2 (PGE-M), prostacyclin (PGI-M), and thromboxane B2 (TxB-M) were quantified at baseline and 24 weeks using gas/liquid chromatography-mass spectroscopy. Mann-Whitney-U tests compared sub-group differences; Spearman's rho assessed correlations between clinical factors and eicosanoid levels. RESULTS Median PGE-M increased on telmisartan (p<0.01), with greater changes in men (+4.1 [p = 0.03] vs. +1.0 ng/mg cr in women; between-group p = 0.25) and participants losing >5% VAT (+3.7 ng/mg cr, p<0.01) and gaining >5% SAT (+1.7 ng/mg cr, p = 0.04). Median baseline F2-IsoP and TxB-M were slightly higher in women (both between-group p = 0.08) and did not change on telmisartan. CONCLUSIONS Urine PGE-M increased with 24 weeks of telmisartan in virally suppressed, HIV+ adults with central adiposity. Associations with favorable fat redistribution suggest increased PGE-M may reflect a beneficial response.
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Affiliation(s)
- Catherine N. Le
- Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Disease, Nashville, Tennessee, United States of America
- * E-mail:
| | - Todd Hulgan
- Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Disease, Nashville, Tennessee, United States of America
| | - Chi-Hong Tseng
- University of California-Los Angeles, Department of Medicine, Division of Infectious Disease, Los Angeles, California, United States of America
| | - Ginger L. Milne
- Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Disease, Nashville, Tennessee, United States of America
| | - Jordan E. Lake
- University of California-Los Angeles, Department of Medicine, Division of Infectious Disease, Los Angeles, California, United States of America
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Abstract
The renin-angiotensin-aldosterone system plays an important role in the pathophysiology of hypertension and is closely related with cardio- and cerebrovascular events and chronic kidney diseases. Each angiotensin receptor blocker (ARB) is important in the treatment of hypertension, according to the results of recent years. This is a practical review of the available evidence on the different benefits of ARBs beyond their blood pressure-lowering effect, with an emphasis on the differences found between the particular compounds and the therapeutic implications of the findings, with specific reference to the co-morbidities.
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Affiliation(s)
- Csaba András Dézsi
- Department of Cardiology, Petz Aladár County Teaching Hospital, Gyor, Hungary.
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Affiliation(s)
- Christos V Rizos
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
| | - Moses S Elisaf
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
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11
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Cataldi M, di Geronimo O, Trio R, Scotti A, Memoli A, Capone D, Guida B. Utilization of antihypertensive drugs in obesity-related hypertension: a retrospective observational study in a cohort of patients from Southern Italy. BMC Pharmacol Toxicol 2016; 17:9. [PMID: 26980335 PMCID: PMC4793753 DOI: 10.1186/s40360-016-0055-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/15/2016] [Indexed: 12/28/2022] Open
Abstract
Background Although the pathophysiological mechanisms of arterial hypertension are different in obese and lean patients, hypertension guidelines do not include specific recommendations for obesity-related hypertension and, therefore, there is a considerable uncertainty on which antihypertensive drugs should be used in this condition. Moreover, studies performed in general population suggested that some antihypertensive drugs may increase body weight, glycemia and LDL-cholesterol but it is unclear how this impact on drug choice in clinical practice in the treatment of obese hypertensive patients. Therefore, in order to identify current preferences of practitioners for obesity-related hypertension, in the present work we evaluated antihypertensive drug therapy in a cohort of 129 pharmacologically treated obese hypertensive patients (46 males and 83 females, aged 51.95 ± 10.1 years) that came to our observation for a nutritional consultation. Methods Study design was retrospective observational. Differences in the prevalence of use of the different antihypertensive drug classes among groups were evaluated with χ2 square analysis. Threshold for statistical significance was set at p < 0.05. Results 41.1 % of the study sample was treated with one, 36.4 % with two and the remaining 22.5 % with three or more antihypertensive drugs. In patients under single drug therapy, β-blockers, ACEIs and ARBs accounted each for about 25 % of prescriptions. The prevalence of use of β-blockers was about sixfold higher in females than males. Diuretics were virtually never used in monotherapy regimens but were used in more than 60 % of patients on dual antihypertensive therapy and in all patients assuming three or more drugs. There was no significant difference in the prevalence of use of any of the aforementioned drugs among patients with obesity of type I, II and III or between patients with or without metabolic syndrome. Conclusions Our data show that no first choice protocol seems to be adopted in clinical practice for the treatment of obesity-related hypertension. Importantly, physicians do not seem to differentiate drug use according to the severity of obesity or to the presence of metabolic syndrome or to avoid drugs known to detrimentally affect body weight and metabolic profile in general population.
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Affiliation(s)
- Mauro Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Via Pansini n°5, Naples, 80131, Italy.
| | - Ornella di Geronimo
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Rossella Trio
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Antonella Scotti
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Andrea Memoli
- Division of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Domenico Capone
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Via Pansini n°5, Naples, 80131, Italy
| | - Bruna Guida
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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Kratochvílová S, Škoch A, Wohl P, Švehlíková E, Dezortová M, Hill M, Hájek M, Pelikánová T. Intramyocellular lipid content in subjects with impaired fasting glucose after telmisartan treatment, a randomised cross-over trial. Magn Reson Imaging 2015; 34:353-8. [PMID: 26523653 DOI: 10.1016/j.mri.2015.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
Ectopic lipid accumulation in skeletal muscle is associated with insulin resistance. Telmisartan improves metabolic parameters in type 2 diabetic patients. The aim of our study was to evaluate the in vivo effect of telmisartan on intramyocellular lipid content (IMCL) in subjects with impaired fasting glucose (IFG) by magnetic resonance spectroscopy (MRS). We enrolled 10 subjects with IFG in a cross-over, placebo-controlled, randomized, double-blind trial, treated with 3 weeks of telmisartan (160 mg daily) or placebo. After completing each treatment, a hyperinsulinaemic euglycaemic clamp (1 mU/kg per min; 5 mmol/l; 120 min) to assess insulin action (metabolic clearance rate of glucose, MCR) and (1)H MRS of the m. tibialis anterior using a MR Scanner Siemens Vision operating at 1.5 T to evaluate IMCL content, were performed. Plasma adipokine levels were determined simultaneously. Telmisartan treatment resulted in a lower fasting plasma glucose (FPG) (p < 0.05), but insulin action was comparable to after placebo. Telmisartan did not affect IMCL content. After placebo, IMCL correlated negatively with total cholesterol (p < 0.001), MCR (p < 0.05) and adiponectin (p < 0.05) and positively with FPG (p < 0.05). After telmisartan treatment there was only a positive correlation between IMCL and TNFα (p < 0.05). IMCL content is related to parameters of glucose metabolism and insulin action in sedentary IFG subjects. A short telmisartan treatment did not affect the IMCL content despite its positive effect on FPG. The improvement in FPG was probably mediated through interference with other metabolic pathways.
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Affiliation(s)
- Simona Kratochvílová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic
| | - Antonín Škoch
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic
| | - Petr Wohl
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic
| | - Eva Švehlíková
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic
| | - Monika Dezortová
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic
| | - Milan Hájek
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic
| | - Terezie Pelikánová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958/4, Prague 140 21, Czech Republic.
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Pushpakom SP, Taylor C, Kolamunnage-Dona R, Spowart C, Vora J, García-Fiñana M, Kemp GJ, Whitehead J, Jaki T, Khoo S, Williamson P, Pirmohamed M. Telmisartan and Insulin Resistance in HIV (TAILoR): protocol for a dose-ranging phase II randomised open-labelled trial of telmisartan as a strategy for the reduction of insulin resistance in HIV-positive individuals on combination antiretroviral therapy. BMJ Open 2015; 5:e009566. [PMID: 26474943 PMCID: PMC4611177 DOI: 10.1136/bmjopen-2015-009566] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Telmisartan, an angiotensin receptor blocker, has beneficial effects on insulin resistance and cardiovascular health in non-HIV populations. This trial will evaluate whether telmisartan can reduce insulin resistance in HIV-positive individuals on combination antiretroviral therapy. METHODS AND ANALYSIS This is a phase II, multicentre, randomised, open-labelled, dose-ranging trial of telmisartan in 336 HIV-positive individuals over a period of 48 weeks. The trial will use an adaptive design to inform the optimal dose of telmisartan. Patients will be randomised initially 1:1:1:1 to receive one of the three doses of telmisartan (20, 40 and 80 mg) or no intervention (control). An interim analysis will be performed when half of the planned maximum of 336 patients have been followed up for at least 24 weeks. The second stage of the study will depend on the results of interim analysis. The primary outcome measure is a reduction in insulin resistance (as measured by Homeostatic Model Assessment-Insulin Resistance (HOMA-IR)) in telmisartan treated arm(s) after 24 weeks of treatment in comparison with the non-intervention arm. The secondary outcome measures include changes in lipid profile; body fat redistribution (as measured by MRI); plasma and urinary levels of various biomarkers of cardiometabolic and renal health at 12, 24 and 48 weeks. Serious adverse events will be compared between different telmisartan treated dose arm(s) and the control arm. ETHICS AND DISSEMINATION The study, this protocol and related documents have been approved by the National Research Ethics Service Committee North West-Liverpool Central (Ref: 12/NW/0214). On successful completion, study data will be shared with academic collaborators. The findings from TAILoR will be disseminated through peer-reviewed publications, at scientific conferences, the media and through patient and public involvement. TRIAL REGISTRATION NUMBERS 04196/0024/001-0001; EUDRACT 2012-000935-18; ISRCTN 51069819.
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Affiliation(s)
- Sudeep P Pushpakom
- Department of Molecular and Clinical Pharmacology, The Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
- MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Claire Taylor
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Ruwanthi Kolamunnage-Dona
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Jiten Vora
- Department of Diabetes and Endocrinology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Graham J Kemp
- Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, UK
| | - John Whitehead
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Paula Williamson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, The Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
- MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Lake JE, Seang S, Kelesidis T, Liao DH, Hodis HN, Stein JH, Currier JS. Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study. HIV CLINICAL TRIALS 2015; 16:197-206. [PMID: 26360501 DOI: 10.1179/1945577115y.0000000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND HIV-infected persons are at increased cardiovascular disease (CVD) risk, but traditional CVD therapies are understudied in this population. Telmisartan is an angiotensin receptor blocker (ARB) and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonist that improves endothelial function and cardiovascular mortality in HIV-uninfected populations. We assessed the effects of telmisartan on endothelial function in older HIV-infected persons at risk for CVD in a small pilot study. METHODS HIV-infected individuals≥50 years old on suppressive antiretroviral therapy (ART) with ≥1 traditional CVD risk factor received open-label telmisartan 80 mg daily for 6 weeks. Brachial artery flow-mediated dilation (FMD) measured endothelial function. The primary endpoint was 6-week change in maximum relative FMD. RESULTS Seventeen participants enrolled; 16 completed all evaluations (88% men, 65% non-White, median age 60 years, CD4+T lymphocyte count 625 cells/mm3). Antiretroviral therapy included 71% protease inhibitor (PI), 29% non-nucleoside reverse transcriptase inhibitor (NNRTI), 29% integrase inhibitor, 65% tenofovir, and 29% abacavir. Cardiovascular disease risk factor prevalence included 76% hyperlipidemia, 65% hypertension, 18% smoking, and 12% diabetes mellitus. After 6 weeks, statistically significant blood pressure changes were observed (systolic-16.0 mmHg, diastolic-6.0 mmHg) without significant changes in FMD. In subset analyses, FMD increased more among abacavir-treated, PI-treated, and non-smoking participants. CONCLUSIONS No significant FMD changes were observed after 6 weeks of telmisartan therapy; however, abacavir- and PI-treated participants and non-smokers showed greater FMD increases. Additional studies are needed to explore the effects of telmisartan on endothelial function among HIV-infected individuals with traditional CVD and/or ART-specific risk factors.
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Visceral fat area is associated with HbA1c but not dialysate-related glucose load in nondiabetic PD patients. Sci Rep 2015; 5:12811. [PMID: 26239161 PMCID: PMC4523850 DOI: 10.1038/srep12811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/03/2015] [Indexed: 01/09/2023] Open
Abstract
Factors associated with increased visceral fat area (VFA) have been well documented in the general population but rarely explored in nondiabetic individuals on peritoneal dialysis (PD). As glycosylated hemoglobin (HbA1c) is positively correlated with VFA in diabetic patients, we hypothesized that the same correlation would exist in nondiabetic PD patients. We enrolled 105 nondiabetic patients who had undergone chronic PD for more than 3 months. Each subject underwent an abdominal computed tomography (CT) scan, and the umbilicus cut was analyzed for VFA. VFA values, corrected for body mass index and subjected to natural logarithm transformations, were examined to determine whether they were correlated with HbA1c and other parameters. PD dialysates prescribed at the time of enrollment were recorded to calculate glucose load. We found that when 105 nondiabetic PD patients were classified according to tertiles of HbA1c, higher HbA1c was associated with larger VFA. Multiple linear regression analysis revealed that HbA1c was an independent determinant of VFA, while glucose load and other PD-specific factors were not. In summary, HbA1c, but not PD-related glucose load, was positively correlated with VFA in nondiabetic PD patients, suggesting clinical utility of HbA1c in the PD population.
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Arumugam S, Sreedhar R, Thandavarayan RA, Karuppagounder V, Krishnamurthy P, Suzuki K, Nakamura M, Watanabe K. Angiotensin receptor blockers: Focus on cardiac and renal injury. Trends Cardiovasc Med 2015; 26:221-8. [PMID: 26169314 DOI: 10.1016/j.tcm.2015.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 12/31/2022]
Abstract
Angiotensin II, an important component of renin angiotensin system, is a potent vasopressor and its actions are mostly mediated via angiotensin II type 1 receptor (AT1R) and role of AT2R in counterbalancing the actions of AT1R stimulation are under extensive research. In addition to its physiological actions, angiotensin II plays important roles in the pathogenesis of atherosclerosis, hypertension, left ventricular hypertrophy, and heart failure. The effects of angiotensin II can be blocked by either suppressing its production by blocking angiotensin converting enzyme or by antagonizing its actions on AT1R using angiotensin II receptor blockers (ARBs). Instead of the extensive use of ARBs in the treatment of various cardiovascular diseases, proper selection of a particular ARB is crucial as the clinical condition of individual patient is different and also their economic status would play an essential role in medication compliance. Thus a critical review of the proven and promising actions of ARBs against various pathological conditions will be of great importance for the clinicians as well as for the researchers.
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Affiliation(s)
- Somasundaram Arumugam
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan
| | - Remya Sreedhar
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan
| | - Rajarajan A Thandavarayan
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan; Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX
| | - Vengadeshprabhu Karuppagounder
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan
| | - Prasanna Krishnamurthy
- Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX
| | - Kenji Suzuki
- Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiko Nakamura
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kenichi Watanabe
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan.
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Chin SH, Item F, Wueest S, Zhou Z, Wiedemann MSF, Gai Z, Schoenle EJ, Kullak-Ublick GA, Al-Hasani H, Konrad D. Opposing effects of reduced kidney mass on liver and skeletal muscle insulin sensitivity in obese mice. Diabetes 2015; 64:1131-41. [PMID: 25325737 DOI: 10.2337/db14-0779] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reduced kidney mass and/or function may result in multiple metabolic derangements, including insulin resistance. However, underlying mechanisms are poorly understood. Herein, we aimed to determine the impact of reduced kidney mass on glucose metabolism in lean and obese mice. To that end, 7-week-old C57BL/6J mice underwent uninephrectomy (UniNx) or sham operation. After surgery, animals were fed either a chow (standard) diet or a high-fat diet (HFD), and glucose homeostasis was assessed 20 weeks after surgery. Intraperitoneal glucose tolerance was similar in sham-operated and UniNx mice. However, insulin-stimulated glucose disposal in vivo was significantly diminished in UniNx mice, whereas insulin-stimulated glucose uptake into isolated skeletal muscle was similar in sham-operated and UniNx mice. Of note, capillary density was significantly reduced in skeletal muscle of HFD-fed UniNx mice. In contrast, hepatic insulin sensitivity was improved in UniNx mice. Furthermore, adipose tissue hypoxia-inducible factor 1α expression and inflammation were reduced in HFD-fed UniNx mice. Treatment with the angiotensin II receptor blocker telmisartan improved glucose tolerance and hepatic insulin sensitivity in HFD-fed sham-operated but not UniNx mice. In conclusion, UniNx protects from obesity-induced adipose tissue inflammation and hepatic insulin resistance, but it reduces muscle capillary density and, thus, deteriorates HFD-induced skeletal muscle glucose disposal.
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Affiliation(s)
- Siew Hung Chin
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland Children's Research Center, University Children's Hospital, Zurich, Switzerland Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Flurin Item
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Stephan Wueest
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Zhou Zhou
- German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Michael S F Wiedemann
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland Children's Research Center, University Children's Hospital, Zurich, Switzerland Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Zhibo Gai
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Eugen J Schoenle
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Gerd A Kullak-Ublick
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Hadi Al-Hasani
- German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany German Center for Diabetes Research, Düsseldorf, Germany
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland Children's Research Center, University Children's Hospital, Zurich, Switzerland Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Telmisartan attenuates the inflamed mesenteric adipose tissue in spontaneous colitis by mechanisms involving regulation of neurotensin/microRNA-155 pathway. Biochem Pharmacol 2015; 93:461-9. [DOI: 10.1016/j.bcp.2014.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/25/2014] [Accepted: 12/30/2014] [Indexed: 02/07/2023]
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Ghigliotti G, Barisione C, Garibaldi S, Fabbi P, Brunelli C, Spallarossa P, Altieri P, Rosa G, Spinella G, Palombo D, Arsenescu R, Arsenescu V. Adipose tissue immune response: novel triggers and consequences for chronic inflammatory conditions. Inflammation 2014; 37:1337-53. [PMID: 24823865 PMCID: PMC4077305 DOI: 10.1007/s10753-014-9914-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adipose tissue inflammation mediates the association between excessive body fat accumulation and several chronic inflammatory diseases. A high prevalence of obesity-associated adipose tissue inflammation was observed not only in patients with cardiovascular conditions but also in patients with inflammatory bowel diseases, abdominal aortic aneurysm, or cardiorenal syndrome. In addition to excessive caloric intake, other triggers promote visceral adipose tissue inflammation followed by chronic, low-grade systemic inflammation. The infiltration and accumulation of immune cells in the inflamed and hypertrophied adipose tissue promote the production of inflammatory cytokines, contributing to target organ damages. This comorbidity seems to delimit subgroups of individuals with systemic adipose tissue inflammation and more severe chronic inflammatory diseases that are refractory to conventional treatment. This review highlights the association between adipose tissue immune response and the pathophysiology of visceral adiposity-related chronic inflammatory diseases, while suggesting several new therapeutic strategies.
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Affiliation(s)
- Giorgio Ghigliotti
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Chiara Barisione
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Silvano Garibaldi
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Patrizia Fabbi
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Claudio Brunelli
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Paolo Spallarossa
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Paola Altieri
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Gianmarco Rosa
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genoa, Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, University of Genoa, Genoa, Italy
| | - Razvan Arsenescu
- IBD Center, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH USA
| | - Violeta Arsenescu
- Mucosal Immunology IBD Laboratory, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, 400W 12 Ave., Wiseman Hall, Room 1024, Columbus, OH 43210 USA
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Sato T, Kameyama T, Ohori T, Matsuki A, Inoue H. Effects of eicosapentaenoic acid treatment on epicardial and abdominal visceral adipose tissue volumes in patients with coronary artery disease. J Atheroscler Thromb 2014; 21:1031-43. [PMID: 24834906 DOI: 10.5551/jat.23390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Epicardial adipose tissue (EAT) is a pathogenic fat depot that may be associated with coronary atherosclerosis and cardiovascular events. Because eicosapentaenoic acid (EPA) has been reported to exert cardiovascular protective effects, we aimed to assess the effects of EPA on the volume of visceral adipose tissue, including EAT and abdominal visceral adipose tissue (AVAT), using multislice computed tomography (CT). METHODS In 30 patients with coronary artery diseases (9 women; mean age, 67.2 ± 5.4 years), EAT and AVAT volumes were compared between the control group (n=15, conventional therapy) and the EPA group (n=15, conventional therapy plus purified EPA 1800 mg/day) during a six-month period. EAT was defined as any pixel that had CT attenuation of -150 to -30 Hounsfield units (HU) within the pericardial sac. RESULTS After the six-month follow-up, the serum EPA level increased from 59.9 ± 18.8 to 177.2 ± 3.3 μg/mL in the EPA group (p<0.01), but no increase was noted in the control group. Similarly, the EPA/arachidonic acid (AA) ratio increased from 0.39 ± 0.12 to 1.22 ± 0.28 in the EPA group (p<0.01), with no significant increase in the control group. The AVAT and EAT volumes decreased in the EPA group but were unchanged in the control group (AVAT, -11.6 ± 17.0 vs. +8.8 ± 13.6 cm(2), p<0.01; EAT, -7.3 ± 8.3 vs. +8.7 ± 8.8 cm(3), p<0.01). Moreover, the change in the AVAT volume negatively correlated with the change in EPA (r=-0.58, p<0.01) and EPA/AA levels (r=-0.53, p<0.01). A similar negative correlation in these parameters was also observed for the EAT volume. CONCLUSIONS Oral intake of purified EPA appears to be associated with reductions in EAT and AVAT volumes.
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Affiliation(s)
- Takao Sato
- The Second Department of Internal Medicine, University of Toyama
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21
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Huang JW, Yang CY, Wu HY, Liu KL, Su CT, Wu CK, Lee JK, Chiang CK, Cheng HT, Lien YC, Hung KY. Metabolic syndrome and abdominal fat are associated with inflammation, but not with clinical outcomes, in peritoneal dialysis patients. Cardiovasc Diabetol 2013; 12:86. [PMID: 23758640 PMCID: PMC3695854 DOI: 10.1186/1475-2840-12-86] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/05/2013] [Indexed: 11/23/2022] Open
Abstract
Background In the general population, metabolic syndrome (MetS) is correlated with visceral fat and a risk factor for cardiovascular disease (CVD); however, little is known about the significance of abdominal fat and its association with inflammation and medication use in peritoneal dialysis (PD) patients. We investigated the relationship of visceral fat area (VFA) with C-reactive protein (CRP) levels and medication use in PD patients and followed their clinical outcomes. Methods In a prospective study from February 2009 to February 2012, we assessed diabetes mellitus (DM) status, clinical and PD-associated characteristics, medication use, CRP levels, components of MetS, and VFA in 183 PD patients. These patients were categorized into 3 groups based on MetS and DM status: non-MetS (group 1, n = 73), MetS (group 2, n = 65), and DM (group 3, n = 45). VFA was evaluated by computed tomography (CT) and corrected for body mass index (BMI). Results Patients in group 1 had smaller VFAs than patients in groups 2 and 3 (3.2 ± 1.8, 4.6 ± 1.9, and 4.9 ± 2.0 cm2/[kg/m2], respectively, P < 0.05) and lower CRP levels (0.97 ± 2.31, 1.27 ± 2.57, and 1.11 ± 1.35 mg/dL, respectively, P < 0.05). VFA increased with the number of criteria met for MetS. After adjusting for age, body weight, and sex, CRP and albumin levels functioned as independent positive predictors of VFA; on other hand, the use of renin-angiotensin system blockers was inversely correlated with VFA in PD patients without DM. In the survival analysis, DM patients (group 3) had the poorest survival among the 3 groups, but no significant differences were found between groups 1 and 2. Conclusion This study showed that VFA and MetS are associated with CRP levels but cannot predict survival in PD patients without DM. The complex relationship of nutritional parameters to VFA and MetS may explain these results. The type of antihypertensive medication used was also associated with the VFA. The mechanisms behind these findings warrant further investigation.
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Jian DY, Chao YW, Ting CH, Huang SW, Chang CF, Juan CC, Chen JY. Losartan ameliorates renal injury, hypertension, and adipocytokine imbalance in 5/6 nephrectomized rats. Eur J Pharmacol 2013; 709:85-92. [DOI: 10.1016/j.ejphar.2013.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 12/13/2022]
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Sarvottam K, Magan D, Yadav RK, Mehta N, Mahapatra SC. Adiponectin, Interleukin-6, and Cardiovascular Disease Risk Factors Are Modified by a Short-Term Yoga-Based Lifestyle Intervention in Overweight and Obese Men. J Altern Complement Med 2013; 19:397-402. [DOI: 10.1089/acm.2012.0086] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kumar Sarvottam
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipti Magan
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nalin Mehta
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil C. Mahapatra
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Lake JE, Tseng CH, Currier JS. A pilot study of telmisartan for visceral adiposity in HIV infection: the metabolic abnormalities, telmisartan, and HIV infection (MATH) trial. PLoS One 2013; 8:e58135. [PMID: 23516440 PMCID: PMC3597631 DOI: 10.1371/journal.pone.0058135] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background Visceral adiposity in the setting of HIV infection and antiretroviral therapy (ART) is not fully understood, and treatment options remain limited. Telmisartan, an angiotensin receptor blocker and partial PPAR-γ agonist, has been shown to decrease visceral fat and improve metabolic and inflammatory parameters in HIV-uninfected subjects. Methods HIV-infected subjects with HIV-1 RNA <50 copies/mL on ART and (women/men) waist circumference >94/95 cm or waist: hip ratio >0.88/0.94 received open-label telmisartan 40 mg po daily for 24 weeks. Adipose tissue (AT) volumes were quantified by L4–L5 single slice computed tomography. Metabolic and inflammatory markers were obtained fasting. Thirty-five subjects provided 80% power to detect a 10% 24-week decrease in visceral AT (VAT, two-sided α = 0.05). Results Thirty-five subjects enrolled and completed the protocol. At entry (median or %): age 49 years, 43% female, 77% non-white, 91% non-smokers, CD4+ T cell count 590 cells/mm3, BMI 31 kg/m2. AT responses were heterogeneous, with statistically significant losses of median (IQR) total (TAT, 2.9% (−9.8, 0.7), p = 0.03) and subcutaneous (SAT, −2.7% (−9.8, 1.1), p = 0.03) AT, but not VAT (−2.7% (−20.5, 14.2), p = 0.53). Significant decreases in waist circumference and waist:hip ratio occurred (both p<0.001) without BMI or weight changes. In an exploratory analysis, significant increases in TNF-α occurred among female subjects without changes in other inflammatory or metabolic markers. No related adverse events occurred. Conclusions Telmisartan was well tolerated. Small losses of AT from all depots were observed after 24 weeks of telmisartan therapy. Further study is needed to determine whether HIV-infected patients can receive metabolic benefits from telmisartan. Trial Registration ClinicalTrials.gov NCT01088295
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Affiliation(s)
- Jordan E Lake
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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Murakami K, Wada J, Ogawa D, Horiguchi CS, Miyoshi T, Sasaki M, Uchida HA, Nakamura Y, Makino H. The effects of telmisartan treatment on the abdominal fat depot in patients with metabolic syndrome and essential hypertension: Abdominal fat Depot Intervention Program of Okayama (ADIPO). Diab Vasc Dis Res 2013; 10:93-6. [PMID: 22561230 DOI: 10.1177/1479164112444640] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Telmisartan partially activates the peroxisome proliferator-activated receptor γ (PPARγ), which may ameliorate the accumulation of visceral adipose tissues and sensitise insulin action. Nineteen patients with essential hypertension and metabolic syndrome were randomly assigned to receive 40 mg of telmisartan (TELMI group) once daily or 80 mg of valsartan (VAL group) once daily for 24 weeks. The visceral fat area (VFA) measured by computed tomography (CT) was significantly reduced from 150.4±15.5 to 127.7±16.7 cm(2) in the TELMI group (p=0.049). Although VFA was also reduced in the VAL group from 169.8±14.8 to 155.3±14.8 cm(2), the change was not significant (p=0.173). There were no significant changes in body weight, body mass index (BMI), waist circumference, subdermal fat area (SFA), fasting plasma glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) in comparison to the baseline and follow-up data in both groups. In conclusion, telmisartan may have a benefit in the reduction of visceral adipose tissues in comparison to valsartan.
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Affiliation(s)
- Kazutoshi Murakami
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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Yu JG, Zhou RR, Cai GJ. From hypertension to stroke: mechanisms and potential prevention strategies. CNS Neurosci Ther 2012; 17:577-84. [PMID: 21951373 DOI: 10.1111/j.1755-5949.2011.00264.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Stroke is a major cause of disability and death worldwide. Prevention aimed at risk factors of stroke is the most effective strategy to curb the stroke pandemic. Hypertension is one of the most important risk factors for stroke. Despite the substantial evidence of the benefits of lowering blood pressure, conventional treatment does not normalize the burden of major cardiovascular events in patients with hypertension. Fully understanding the factors involved in the hypertension-induced stroke helps to develop new strategies for stroke prevention. Antihypertensive therapies selected should have positive blood pressure-independent effects on stroke risk. This review summarizes the factors involved in the hypertension-induced stroke, such as oxidative stress, inflammation, and arterial baroreflex dysfunction, and potential strategies for its prevention, therefore, provides clues for clinicians.
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Affiliation(s)
- Jian-Guang Yu
- Department of Pharmacology, Second Military Medical University, Shanghai, China
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Kubik M, Chudek J, Adamczak M, Wiecek A. Telmisartan improves cardiometabolic profile in obese patients with arterial hypertension. Kidney Blood Press Res 2012; 35:281-9. [PMID: 22378488 DOI: 10.1159/000334951] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 11/04/2011] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE There are several lines of evidence that telmisartan may improve cardiometabolic profile. The aim of the study was to estimate changes of insulin resistance and plasma concentrations of adipokines after long-term antihypertensive treatment with telmisartan in obese hypertensive patients. METHODS 34 previously untreated obese adults with arterial hypertension were enrolled. Glucose cellular uptake (M value) and the M to insulin ratio (M/I value) were measured by euglycemic-hyperinsulinemic clamp technique, body fat content (by dual-energy X-ray absorptiometry method), as well as plasma concentrations of selected adipokines and cytokines were estimated before and after 6-month telmisartan therapy in 25 patients who completed the study. RESULTS Telmisartan therapy was followed by 14.2% decrease of systolic and by 19.6% decrease of diastolic blood pressure. Body fat mass did not change significantly. Both M and M/I values (by 24.4 and by 38.6%, respectively) as well as plasma levels of total and high-molecular-weight adiponectin (by 10.8 and by 23.5%, respectively) increased significantly. Plasma concentrations of high-sensitivity C- reactive protein and interleukin-8 decreased significantly, while those of interleukin-6 and tumor necrosis factor-α tended to decline. CONCLUSIONS Telmisartan monotherapy improves cardiometabolic profile in obese hypertensive patients by improving insulin sensitivity and increasing of plasma adiponectin concentration, including its high-molecular-weight fraction, and by suppressing of microinflammation.
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Affiliation(s)
- Małgorzata Kubik
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
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Demyanets S, Huber K, Wojta J. Vascular effects of glycoprotein130 ligands--part II: biomarkers and therapeutic targets. Vascul Pharmacol 2012; 57:29-40. [PMID: 22245786 DOI: 10.1016/j.vph.2011.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 12/15/2011] [Accepted: 12/25/2011] [Indexed: 12/13/2022]
Abstract
Glycoprotein130 (gp130) ligands are defined by the use of the common receptor subunit gp130 and comprise interleukin (IL)-6, oncostatin M (OSM), IL-11, leukemia inhibitory factor (LIF), cardiotrophin-1 (CT-1), cardiotrophin-like cytokine (CLC), ciliary neurotrophic factor (CNTF), IL-27 and neuropoietin (NP). In part I of this review we addressed the pathophysiological functions of gp130 ligands with respect to the vascular wall. In part II of this review on the vascular effects of gp130 ligands we will discuss data about possible use of these molecules as biomarkers to predict development or progression of cardiovascular diseases. Furthermore, the possibility to modulate circulating levels of gp130 ligands or their tissue expression by specific antibodies, soluble gp130 protein, renin-angiotensin-aldosterone system (RASS) inhibitors, statins, agonists of peroxisome proliferator-activated receptors (PPAR), hormone replacement therapy, nonsteroidal anti-inflammatory drugs (NSAID) or lifestyle modulating strategies are presented. Recent knowledge about the application of recombinant cytokines from the gp130 cytokine family as therapeutic agents in obesity or atherosclerosis is also summarized. Thus the purpose of this review is to cover a possible usefulness of gp130 ligands as biomarkers and targets for therapy in cardiovascular pathologies.
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Affiliation(s)
- Svitlana Demyanets
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Westerink J, Visseren FLJ. Pharmacological and non-pharmacological interventions to influence adipose tissue function. Cardiovasc Diabetol 2011; 10:13. [PMID: 21276223 PMCID: PMC3039566 DOI: 10.1186/1475-2840-10-13] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/28/2011] [Indexed: 12/31/2022] Open
Abstract
Obesity is associated with metabolic derangements such as insulin resistance, inflammation and hypercoagulobility which can all be understood as consequences of adipose tissue dysfunction. The potential role for adipose tissue derived cytokines and adipokines in the development of vascular disease and diabetes may produce a clinical need to influence adipose tissue function. Various pharmacological and non-pharmacological interventions affect plasma cytokine and adipokine levels. The effects of these interventions depend on weight loss per se, changes in fat distribution without weight loss and/or direct effects on adipose tissue inflammation. Weight loss, as a result of diet, pharmacology and surgery, positively influences plasma adipokines and systemic inflammation. Several classes of drugs influence systemic inflammation directly through their anti-inflammatory actions. PPAR-γ agonism positively influences adipose tissue inflammation in several classes of intervention such as the thiazolidinediones and perhaps salicylates, CB1-antagonists and angiotensin II receptor blockers. Furthermore, within drug classes there are differential effects of individual pharmacologic agents on adipose tissue function. It can be concluded that several commonly used pharmacological and non-pharmacological interventions have unintended influences on adipose tissue function. Improving adipose tissue function may contribute to reducing the risk of vascular diseases and the development of type 2 diabetes.
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Affiliation(s)
- Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
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Comparison of the effects of losartan vs. ramipril on several adipocytokines and vascular remodeling biomarkers. Hypertens Res 2011; 34:52-4. [DOI: 10.1038/hr.2010.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wago T, Yoshimoto T, Akaza I, Tsuchiya K, Izumiyama H, Doi M, Hirata Y. Improvement of endothelial function in patients with hypertension and type 2 diabetes after treatment with telmisartan. Hypertens Res 2010; 33:796-801. [DOI: 10.1038/hr.2010.107] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Siegel D, Swislocki AL. Hypertensive Treatment in Patients With Metabolic Syndrome. Metab Syndr Relat Disord 2010; 8:95-104. [DOI: 10.1089/met.2009.0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- David Siegel
- Medical Service, Department of Veterans Affairs, Northern California Health Care System, Mather, California
- Department of Medicine, School of Medicine, University of California–Davis, Davis, California
| | - Arthur L.M. Swislocki
- Medical Service, Department of Veterans Affairs, Northern California Health Care System, Mather, California
- Department of Medicine, School of Medicine, University of California–Davis, Davis, California
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Telmisartan: a different angiotensin II receptor blocker protecting a different population? J Int Med Res 2010; 37:1662-79. [PMID: 20146864 DOI: 10.1177/147323000903700602] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET()) showed that the angiotensin II receptor blocker (ARB) telmisartan was as protective as the reference-standard ramipril in a broad cross-section of patients at increased cardiovascular risk, but was better tolerated. Telmisartan has a unique profile among ARBs, with a high affinity for the angiotensin II type 1 receptor, a long duration of receptor binding, a high lipophilicity and a long plasma half life. This leads to sustained and powerful blood pressure lowering when compared with the first marketed ARBs, such as losartan and valsartan. Some pharmacological properties of telmisartan clearly distinguish it from other members of the ARB class and may contribute to the clinical effects seen with telmisartan. A class effect for ARBs cannot be assumed. To date, telmisartan is the only ARB that has been shown to reduce cardiovascular risk in at-risk cardiovascular patients.
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He H, Yang D, Ma L, Luo Z, Ma S, Feng X, Cao T, Yan Z, Liu D, Tepel M, Zhu Z. Telmisartan prevents weight gain and obesity through activation of peroxisome proliferator-activated receptor-delta-dependent pathways. Hypertension 2010; 55:869-79. [PMID: 20176998 DOI: 10.1161/hypertensionaha.109.143958] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Telmisartan shows antihypertensive and several pleiotropic effects that interact with metabolic pathways. In the present study we tested the hypothesis that telmisartan prevents adipogenesis in vitro and weight gain in vivo through activation of peroxisome proliferator-activated receptor (PPAR)-delta-dependent pathways in several tissues. In vitro, telmisartan significantly upregulated PPAR-delta expression in 3T3-L1 preadipocytes in a time- and dose-dependent manner. Other than enhancing PPAR-delta expression by 68.2+/-17.3% and PPAR-delta activity by 102.0+/-9.0%, telmisartan also upregulated PPAR-gamma expression, whereas neither candesartan nor losartan affected PPAR-delta expression. In vivo, long-term administration of telmisartan significantly reduced visceral fat and prevented high-fat diet-induced obesity in wild-type mice and hypertensive rats but not in PPAR-delta knockout mice. Administration of telmisartan did not influence food intake in mice. Telmisartan influenced several lipolytic and energy uncoupling related proteins (UCPs) and enhanced phosphorylated protein kinase A and hormone sensitive lipase but reduced perilipin expression and finally inhibited adipogenesis in 3T3-L1 preadipocytes. Telmisartan-associated reduction of adipogenesis in preadipocytes was significantly blocked after PPAR-delta gene knockout. Chronic telmisartan treatment upregulated the expressions of protein kinase A, hormone-sensitive lipase, and uncoupling protein 1 but reduced perilipin expression in adipose tissue and increased uncoupling protein 2 and 3 expression in skeletal muscle in wild-type mice but not in PPAR-delta knockout mice. We conclude that telmisartan prevents adipogenesis and weight gain through activation of PPAR-delta-dependent lipolytic pathways and energy uncoupling in several tissues.
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Affiliation(s)
- Hongbo He
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing 400042, People's Republic of China
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Abstract
Inflammation is a key feature in the initiation, progression, and clinical implications of cardiovascular disorders, including essential hypertension. Increasing evidence shows that activation of renin-angiotensin-aldosterone system and enhanced local production of angiotensin II have been implicated in the pathophysiology of inflammation. Besides being a potent vasoactive peptide, angiotensin II regulates the inflammatory process. Specifically, it increases vascular permeability, participates in the recruitment of inflammatory cells and their adhesion to the activated endothelium, and regulates cell growth and fibrosis. Reactive oxygen species are implicated at every stage in inflammation and activate multiple intracellular signaling molecules and transcription factors associated with inflammatory responses, such as nuclear factor-kappa B and activator protein-1. Other components of the renin-angiotensin-aldosterone system, including aldosterone and/or mineralocorticoid receptor, induce the production of reactive oxygen species and participate in vascular inflammation. Several studies suggest a role of endothelin-1 as an important mediator of chronic inflammation and there is an increasing interest in the relationship between endothelin-1 and reactive oxygen species. These data may have great impact on future therapeutic strategies.
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Production and secretion of adiponectin from 3T3-L1 adipocytes: comparison of antihypertensive drugs. Am J Hypertens 2009; 22:1126-9. [PMID: 19730415 DOI: 10.1038/ajh.2009.171] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Adiponectin is an important vascular protective adipocytokine that possesses antidiabetic, antiatherogenic, and anti-inflammatory properties. The aim of this study was to evaluate the effect of various antihypertensive drugs on the production and secretion of adiponectin from adipocytes. METHODS 3T3-L1 adipocytes were incubated for 6 h with increased doses of the following drugs: hydrochlorothiazide, atenolol, losartan, telmisartan, captopril, and nifedipine. Adiponectin levels, as well as adiponectin-mRNA expression, were measured in the medium and cells. RESULTS Significant increases of adiponectin were induced by telmisartan: 56% with a dose of 0.1 micromol/l (P < 0.05), 131% with 10 micromol/l (P < 0.05), and 125% with 100 micromol/l (P < 0.01). Losartan (100 micromol/l) also increased adiponectin by 65% (P < 0.05). Conversely, hydrochlorothiazide, 0.1 micromol/l, reduced adiponectin by 37% (P < 0.01). Captopril, atenolol, and nifedipine had no effect on adiponectin. Gene expression of adiponectin correlated with these results: with telmisartan, it increased by 27%, and with hydrochlorothiazide it decreased by 38% (P < 0.05 for both compared to the control). CONCLUSION In this comparative model, telmisartan, and to a lesser extent, losartan, increased production and secretion of adiponectin from 3T3-L1 adipocytes compared to the other antihypertensive drugs.
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Angeli F, Reboldi G, Gentile G, Verdecchia P. The emerging role of high-density lipoprotein cholesterol in hypertension trials. J Hypertens 2009; 27:458-60. [DOI: 10.1097/hjh.0b013e3283232a59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effects of losartan compared with atenolol on lipids in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2009; 27:567-74. [DOI: 10.1097/hjh.0b013e32831daf96] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guo X, Chen XP, Cheng ZN, Luo X, Guo R, Chen L, Chen J, Chen B, Peng J, Li YJ. No effect of MDR1 C3435T polymorphism on oral pharmacokinetics of telmisartan in 19 healthy Chinese male subjects. Clin Chem Lab Med 2009; 47:38-43. [DOI: 10.1515/cclm.2009.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Iwata A, Miura SI, Mori K, Kawamura A, Nishikawa H, Saku K. Associations between Metabolic Factors and Coronary Plaque Growth or Arterial Remodeling as Assessed by Intravascular Ultrasound in Patients with Stable Angina. Hypertens Res 2008; 31:1879-86. [DOI: 10.1291/hypres.31.1879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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