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Shah SS, Zhang J, Gwini SM, Young MJ, Fuller PJ, Yang J. Efficacy and safety of mineralocorticoid receptor antagonists for the treatment of low-renin hypertension: a systematic review and meta-analysis. J Hum Hypertens 2024:10.1038/s41371-023-00891-1. [PMID: 38200100 DOI: 10.1038/s41371-023-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
Hypertension is the leading risk factor for premature death. The optimal treatment of low-renin hypertension (LRH), present in 30% of hypertensive individuals, is not known. LRH likely reflects a state of excess salt, expanded volume and/or mineralocorticoid receptor (MR) activation. Therefore, targeted treatment with MR antagonists (MRA) may be beneficial. The objective of this systematic review was to assess the efficacy of MRA therapy in LRH. MEDLINE, Embase and Cochrane databases were searched for randomised controlled trials of adults with LRH that compared the efficacy of MRA to placebo or other antihypertensive treatments. Risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis was performed using a random-effects model to estimate the difference in blood pressure and the certainty of evidence was assessed using the GRADE approach. The protocol is registered on PROSPERO (CRD42022318763). From the 1612 records identified, 17 studies met the inclusion criteria with a total sample size of 1043 participants. Seven studies (n = 345) were assessed as having a high risk of bias. Meta-analysis indicated that MRA reduced systolic blood pressure by -6.8 mmHg (95% confidence interval -9.6 to -4.1) and -4.8 mmHg (95% confidence interval -11.9 to 2.4) compared to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) and diuretics. The certainty of the evidence was assessed as moderate and very low, respectively. The findings of this systematic review suggest that MRA is effective in lowering blood pressure in LRH and may be better than ACEi/ARB. Translation to clinical practice is limited by the uncertainty of evidence.
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Affiliation(s)
- Sonali S Shah
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Vic, Australia
| | - Jinghong Zhang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Stella May Gwini
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Vic, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia.
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia.
- Department of Molecular and Translational Science, Monash University, Clayton, Vic, Australia.
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Kanki M, Nath AP, Xiang R, Yiallourou S, Fuller PJ, Cole TJ, Cánovas R, Young MJ. Poor sleep and shift work associate with increased blood pressure and inflammation in UK Biobank participants. Nat Commun 2023; 14:7096. [PMID: 37925459 PMCID: PMC10625529 DOI: 10.1038/s41467-023-42758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
Disrupted circadian rhythms have been linked to an increased risk of hypertension and cardiovascular disease. However, many studies show inconsistent findings and are not sufficiently powered for targeted subgroup analyses. Using the UK Biobank cohort, we evaluate the association between circadian rhythm-disrupting behaviours, blood pressure (SBP, DBP) and inflammatory markers in >350,000 adults with European white British ancestry. The independent U-shaped relationship between sleep length and SBP/DBP is most prominent with a low inflammatory status. Poor sleep quality and permanent night shift work are also positively associated with SBP/DBP. Although fully adjusting for BMI in the linear regression model attenuated effect sizes, these associations remain significant. Two-sample Mendelian Randomisation (MR) analyses support a potential causal effect of long sleep, short sleep, chronotype, daytime napping and sleep duration on SBP/DBP. Thus, in the current study, we present a positive association between circadian rhythm-disrupting behaviours and SBP/DBP regulation in males and females that is largely independent of age.
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Affiliation(s)
- Monica Kanki
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine (Alfred Health), Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Artika P Nath
- Cambridge-Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ruidong Xiang
- Cambridge-Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Stephanie Yiallourou
- Turner Institute for Brain and Mental Health, Department of Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Peter J Fuller
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Timothy J Cole
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - Rodrigo Cánovas
- Cambridge-Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Health and Biosecurity, Australian e-Health Research Centre, CSIRO, Melbourne, VIC, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia.
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Woode ME, Wong K, Reid CM, Stowasser M, Russell G, Gwini S, Young MJ, Fuller PJ, Yang J, Chen G. Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: a Markov modelling analysis. J Hypertens 2023; 41:1615-1625. [PMID: 37466447 DOI: 10.1097/hjh.0000000000003513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Primary aldosteronism affects 3-14% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although primary aldosteronism screening is recommended in patients with treatment-resistant hypertension, diagnosis at an earlier stage of disease may prevent end-organ damage and optimize patient outcomes. METHODS A Markov model was used to estimate the cost-effectiveness of screening for primary aldosteronism in treatment and disease (cardiovascular disease and stroke) naive hypertensive patients. Within the model, a 40-year-old patient with hypertension went through either the screened or the unscreened arm of the model. They were followed until age 80 or death. In the screening arm, the patient underwent standard diagnostic testing for primary aldosteronism if the screening test, aldosterone-to-renin ratio, was elevated above 70 pmol/l : mU/l. Diagnostic accuracies, transition probabilities and costs were derived from published literature and expert advice. The main outcome of interest was the incremental cost effectiveness ratio (ICER). RESULTS Screening hypertensive patients for primary aldosteronism compared with not screening attained an ICER of AU$35 950.44 per quality-adjusted life year (QALY) gained. The results were robust to different sensitivity analyses. Probabilistic sensitivity analysis demonstrated that in 73% of the cases, it was cost-effective to screen at the commonly adopted willingness-to-pay (WTP) threshold of AU$50 000. CONCLUSION The results from this study demonstrated that screening all hypertensive patients for primary aldosteronism from age 40 is cost-effective. The findings argue in favour of screening for primary aldosteronism before the development of severe hypertension in the Australian healthcare setting.
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Affiliation(s)
- Maame Esi Woode
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East
- Victorian Heart Institute, Monash University
| | - Kristina Wong
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
- Department of Medicine, Monash University, Clayton, Victoria
| | - Christopher M Reid
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Queensland
| | - Grant Russell
- Department of General Practice, Monash University, Clayton
| | - StellaMay Gwini
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria
- University Hospital Geelong, Barwon Health, Geelong
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
- Department of Medicine, Monash University, Clayton, Victoria
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East
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Alexander SPH, Cidlowski JA, Kelly E, Mathie AA, Peters JA, Veale EL, Armstrong JF, Faccenda E, Harding SD, Davies JA, Coons L, Fuller PJ, Korach KS, Young MJ. The Concise Guide to PHARMACOLOGY 2023/24: Nuclear hormone receptors. Br J Pharmacol 2023; 180 Suppl 2:S223-S240. [PMID: 38123152 DOI: 10.1111/bph.16179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
The Concise Guide to PHARMACOLOGY 2023/24 is the sixth in this series of biennial publications. The Concise Guide provides concise overviews, mostly in tabular format, of the key properties of approximately 1800 drug targets, and nearly 6000 interactions with about 3900 ligands. There is an emphasis on selective pharmacology (where available), plus links to the open access knowledgebase source of drug targets and their ligands (https://www.guidetopharmacology.org/), which provides more detailed views of target and ligand properties. Although the Concise Guide constitutes almost 500 pages, the material presented is substantially reduced compared to information and links presented on the website. It provides a permanent, citable, point-in-time record that will survive database updates. The full contents of this section can be found at http://onlinelibrary.wiley.com/doi/10.1111/bph.16179. Nuclear hormone receptors are one of the six major pharmacological targets into which the Guide is divided, with the others being: G protein-coupled receptors, catalytic receptors, enzymes and transporters. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. The landscape format of the Concise Guide is designed to facilitate comparison of related targets from material contemporary to mid-2023, and supersedes data presented in the 2021/22, 2019/20, 2017/18, 2015/16 and 2013/14 Concise Guides and previous Guides to Receptors and Channels. It is produced in close conjunction with the Nomenclature and Standards Committee of the International Union of Basic and Clinical Pharmacology (NC-IUPHAR), therefore, providing official IUPHAR classification and nomenclature for human drug targets, where appropriate.
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Affiliation(s)
- Stephen P H Alexander
- School of Life Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK
| | - John A Cidlowski
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, 27709, USA
| | - Eamonn Kelly
- School of Allied Health Sciences, University of Bristol, Bristol, BS8 1TD, UK
| | - Alistair A Mathie
- School of Engineering, Arts, Science and Technology, University of Suffolk, Ipswich, IP4 1QJ, UK
| | - John A Peters
- Neuroscience Division, Medical Education Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - Emma L Veale
- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent, ME4 4TB, UK
| | - Jane F Armstrong
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Elena Faccenda
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Simon D Harding
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Jamie A Davies
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | | | - Peter J Fuller
- Hudson Institute of Medical Research, Clayton, Australia
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Lai JH, Gwini SM, Chen G, Long KM, Russell G, Schlaich MP, Stowasser M, Young MJ, Fuller PJ, Mori TA, Wolley M, Reid CM, Yang J. Willingness to be tested for a secondary cause of hypertension: a survey of the Australian general community. Intern Med J 2023; 53:1826-1836. [PMID: 36321804 DOI: 10.1111/imj.15955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Primary aldosteronism (PA) represents the most common and potentially curable cause of secondary hypertension. However, PA is not commonly screened for, and up to 34% of patients who screen positive do not complete the full diagnostic process. This suggests that the diagnostic process may pose a barrier to patients and may contribute to the under-diagnosis of PA. AIMS To evaluate the willingness of the Australian general public to undergo testing for secondary causes of hypertension and identify enablers or barriers to testing from the patients' perspective. METHODS An online survey containing questions on knowledge and attitudes towards hypertension, willingness to be tested and enablers/barriers towards testing was distributed to the Australian community. RESULTS Of 520 adult respondents (mean age 50.4 years, SD 27.3 years; 28.8% hypertensive; 56.0% female), the majority of non-hypertensive and hypertensive respondents (82.7% vs 70.0%; P = 0.03) were willing to undergo testing for a secondary cause of hypertension that involved blood and urine tests. Greater knowledge of hypertensive risk modification strategies and complications was predictive of willingness to be tested, whereas age, sex, education level, geographic location, socio-economic status and cardiovascular comorbidities were not. The top three barriers to testing included fear of a serious underlying condition, lack of belief in further testing and increased stress associated with further testing. CONCLUSION A high proportion of patients are willing to engage in testing for a secondary cause of hypertension. Education about the risks associated with hypertension and the testing process may overcome several barriers to testing.
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Affiliation(s)
- Jordan H Lai
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Stella M Gwini
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Katrina M Long
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia - Royal Perth Hospital Campus, Perth, Western Australia, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
| | - Trevor A Mori
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Martin Wolley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine; Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
- Department of Nephrology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
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Ng E, Gwini SM, Stowasser M, Young MJ, Fuller PJ, Singh GR, Yang J. Aldosterone and renin concentrations and blood pressure in young Indigenous and non-Indigenous adults in the Northern Territory: a cross-sectional study. Med J Aust 2023; 219:263-269. [PMID: 37573148 DOI: 10.5694/mja2.52062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To evaluate aldosterone and renin levels and aldosterone-to-renin ratios (ARRs) in young Indigenous and non-Indigenous adults in the Northern Territory, and their association with blood pressure levels. DESIGN Cross-sectional study; single time point sub-study of two prospective birth cohort studies. SETTING, PARTICIPANTS Participants in the Aboriginal Birth Cohort (ABC) - born to Indigenous mothers at the Royal Darwin Hospital during 1987-1990 - and the Top End Cohort (TEC) - people born to non-Indigenous mothers in Darwin, recruited during 2007-2009 - aged 32-35 years at the time of this sub-study. MAIN OUTCOME MEASURES Plasma aldosterone and direct renin concentrations; ARRs (positive screening test result for primary aldosteronism defined as > 70 pmol/mU); systolic and diastolic blood pressure. RESULTS A total of 255 ABC (205 in remote, 50 in urban locations) and 76 TEC members participated. Median aldosterone concentration was similar for all three groups. The median renin concentration was 7.5 mU/L (interquartile range [IQR], 4.1-12.4 mU/L) in the TEC group, 12.4 mU/L (IQR, 5.1-19 mU/L) in the urban ABC group, and 29.3 mU/L (IQR, 15.0-52.9 mU/L) in the remote ABC group. The median ARR was 10 pmol/mU (IQR, 6-19 pmol/mU) in the remote ABC group, 28 pmol/mU (IQR, 16-70 pmol/mU) in the urban ABC group, and 43 pmol/mU (IQR, 26-74 pmol/mU) in the TEC group. Thirteen urban ABC participants (26%), 21 TEC participants (28%), and six people in the remote ABC group (3%) had ARR values above 70 pmol/mU. Adjusted for age and body mass index (BMI), mean systolic and diastolic blood pressure were lower for women than men in all participant groups; after adjusting for age, sex, and BMI, larger ARR was associated with higher systolic blood pressure in the TEC group but not the two ABC groups. CONCLUSION Screening test results for primary aldosteronism were positive for about one-quarter of urban Indigenous and non-Indigenous participants. A prospective study that includes confirmatory testing would more accurately assess the prevalence of primary aldosteronism among Indigenous Australians in the Northern Territory.
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Affiliation(s)
- Elisabeth Ng
- Monash Health, Melbourne, VIC
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, VIC
| | - Stella M Gwini
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, VIC
- Monash University, Melbourne, VIC
| | | | | | - Peter J Fuller
- Monash Health, Melbourne, VIC
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, VIC
| | | | - Jun Yang
- Monash Health, Melbourne, VIC
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, VIC
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Yang J, Young MJ, Cole TJ, Fuller PJ. Mineralocorticoid receptor signalling in primary aldosteronism. J Endocrinol 2023; 259:e220249. [PMID: 37486000 DOI: 10.1530/joe-22-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/24/2023] [Indexed: 07/25/2023]
Abstract
Primary aldosteronism, or Conn syndrome, is the most common endocrine cause of hypertension. It is associated with a higher risk of cardiovascular, metabolic and renal diseases, as well as a lower quality of life than for hypertension due to other causes. The multi-systemic effects of primary aldosteronism can be attributed to aldosterone-mediated activation of the mineralocorticoid receptor in a range of tissues. In this review, we explore the signalling pathways of the mineralocorticoid receptor, with a shift from the traditional focus on the regulation of renal sodium-potassium exchange to a broader understanding of its role in the modulation of tissue inflammation, fibrosis and remodelling. The appreciation of primary aldosteronism as a multi-system disease with tissue-specific pathophysiology may lead to more vigilant testing and earlier institution of targeted interventions.
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Affiliation(s)
- Jun Yang
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Discovery & Preclinical Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Timothy J Cole
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Peter J Fuller
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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Carvajal CA, Young MJ, Romero DG. Editorial: Novel biomarkers and extracellular vesicles in endocrine hypertension and related disorders. Front Endocrinol (Lausanne) 2023; 14:1262046. [PMID: 37645410 PMCID: PMC10461625 DOI: 10.3389/fendo.2023.1262046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Cristian A. Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Research in Endocrinology (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Morag J. Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Damian G. Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, United States
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, United States
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Yang J, Gwini SM, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori TA. Effect of Oral Contraception on Screening Tests for Primary Aldosteronism: A 10-Year Longitudinal Study. J Clin Endocrinol Metab 2023; 108:1686-1695. [PMID: 36633572 DOI: 10.1210/clinem/dgad010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
CONTEXT Primary aldosteronism (PA) and oral contraception (OC) can both cause hypertension in young women. However, the effect of OC on the screening test for PA, the aldosterone to renin ratio (ARR), is not clear. OBJECTIVE We evaluated the impact of OC on the screening test for PA. METHODS In this retrospective cohort study, we analyzed data from the female offspring (Gen2) of women enrolled in the Raine Study, a population-based birth cohort, who had blood pressure (BP) measurements, blood samples, and information about OC use at age 17 years (N = 484) and/or age 27 years (N = 486). RESULTS Aldosterone concentration was significantly higher in OC users than nonusers at 17 years (median 486 pmol/L vs 347 pmol/L, P < 0.001). Renin concentration was significantly lower in OC users at both 17 years (13.4 mU/L vs 20.6 mU/L) and 27 years (9.2 mU/L vs 11.8 mU/L), hence the ARR was significantly higher in OC users compared to nonusers at both 17 years (31.5 vs 18.3) and 27 years (27.3 vs 21.1). The proportion of participants with ARR > 70 pmol/mU (current threshold for PA detection) was significantly higher in OC users at both 17 years (12.6% vs 2.1%) and 27 years (6.4% vs 0.4%); however, they had comparable BP to those with ARR < 70. OC use at any age abolished the relationship between ARR and BP that is observed in nonusers. CONCLUSION OC can increase the ARR and cause a false positive PA screening result. Until more reliable criteria for PA screening in OC users are established, alternative contraception should be considered during screening.
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Affiliation(s)
- Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Stella May Gwini
- Department of Biostatistics, University Hospital Geelong, Barwon Health, Victoria 3220, Australia
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Lawrence J Beilin
- Medical School, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia - Royal Perth Hospital Campus, Perth, Western Australia 6000, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth 6000, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Victoria 3004, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Trevor A Mori
- Medical School, The University of Western Australia, Crawley, Western Australia 6009, Australia
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Fuller PJ, Young MJ, Yang J, Cole TJ. Structure-function relationships of the aldosterone receptor. Vitam Horm 2023; 123:285-312. [PMID: 37717989 DOI: 10.1016/bs.vh.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The cellular response to the adrenal steroid aldosterone is mediated by the mineralocorticoid receptor (MR), a member of the nuclear receptor superfamily of ligand-dependent transcription factors. The MR binds more than one physiological ligand with binding at the MR determined by pre-receptor metabolism of glucocorticoid ligands by 11β hydroxysteroid dehydrogenase type 2. The MR has a wide tissue distribution with multiple roles beyond the classical role in electrolyte homeostasis including cardiovascular function, immune cell signaling, neuronal fate and adipocyte differentiation. The MR has three principal functional domains, an N-terminal ligand domain, a central DNA binding domain and a C-terminal, ligand binding domain, with structures having been determined for the latter two domains but not for the whole receptor. MR signal-transduction can be best viewed as a series of interactions which are determined by the conformation conferred on the receptor by ligand binding. This conformation then determines subsequent intra- and inter-molecular interactions. These interactions include chromatin, coregulators and other transcription factors, and additional less well characterized cytoplasmic non-genomic effects via crosstalk with other signaling pathways. This chapter will provide a review of MR structure and function, and an analysis of the critical interactions involved in MR-mediated signal transduction, which contribute to ligand- and tissue-specificity. Understanding the relevant mechanisms for selective MR signaling in terms of these interactions opens the possibility of novel therapeutic approaches for the treatment of MR-mediated diseases.
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Affiliation(s)
- Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia.
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; University of Melbourne and Baker HDI Department of Cardiometabolic Health and Disease, Melbourne, VIC, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia
| | - Timothy J Cole
- Department of Biochemistry & Molecular Biology, Monash University, Clayton, VIC, Australia
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11
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Clyne CD, Kusnadi KP, Cowcher A, Morgan J, Yang J, Fuller PJ, Young MJ. Regulation of mineralocorticoid receptor activation by circadian protein TIMELESS. J Mol Endocrinol 2023; 70:JME-21-0279. [PMID: 36099062 DOI: 10.1530/jme-21-0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 01/19/2023]
Abstract
The mineralocorticoid receptor (MR) is a ligand-activated transcription factor that regulates cardiorenal physiology and disease. Ligand-dependent MR transactivation involves a conformational change in the MR and recruitment of coregulatory proteins to form a unique DNA-binding complex at the hormone response element in target gene promoters. Differences in the recruitment of coregulatory proteins can promote tissue-, ligand- or gene-specific transcriptional outputs. The goal of this study was to evaluate the circadian protein TIMELESS as a selective regulator of MR transactivation. TIMELESS has an established role in cell cycle regulation and DNA repair. TIMELESS may not be central to mammalian clock function and does not bind DNA; however, RNA and protein levels oscillate over 24 h. Co-expression of TIMELESS down-regulated MR transactivation of an MR-responsive reporter in HEK293 cells, yet enhanced transactivation mediated by other steroid receptors. TIMELESS markedly inhibited MR transactivation of synthetic and native gene promoters and expression of MR target genes in H9c2 cardiac myoblasts. Immunofluorescence showed aldosterone induces colocalisation of TIMELESS and MR, although a direct interaction was not confirmed by coimmunoprecipitation. Potential regulation of circadian clock targets cryptochrome 1 and 2 by TIMELESS was not detected. However, our data suggest that these effects may involve TIMELESS coactivation of oestrogen receptor alpha (ERα). Taken together, these data suggest that TIMELESS may contribute to MR transcriptional outputs via enhancing ERα inhibitory actions on MR transactivation. Given the variable expression of TIMELESS in different cell types, these data offer new opportunities for the development of MR modulators with selective actions.
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Affiliation(s)
- Colin D Clyne
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia
| | - Kevin P Kusnadi
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Alexander Cowcher
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia
| | - James Morgan
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- University of Melbourne and Baker HDI Department of Cardiometabolic Health and Disease, Melbourne, Australia
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12
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Solanki P, Gwini SM, Libianto R, Gabb G, Shen J, Young MJ, Fuller PJ, Yang J. Risky business: a single-centre cross-sectional analysis of calculated cardiovascular risk in patients with primary aldosteronism and essential hypertension. BMJ Open 2022; 12:e062406. [PMID: 36375972 PMCID: PMC9664285 DOI: 10.1136/bmjopen-2022-062406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Primary aldosteronism (PA), the most common endocrine cause of hypertension, is associated with a higher risk of cardiovascular disease (CVD) than blood pressure (BP)-matched essential hypertension (EH). We aimed to compare the calculated risks of CVD in patients who had hypertension with PA or EH using CVD risk calculators, hypothesising that they will fail to recognise the increased CVD risk in PA. DESIGN Cross-sectional analysis. SETTING An endocrine hypertension service in Victoria, Australia. PARTICIPANTS Patients who had hypertension without CVD referred for the investigation of hypertension. OUTCOME MEASURES Calculated 5-year or 10-year CVD risk as predicted by the National Vascular Disease Prevention Alliance (NVDPA) algorithm, Framingham Risk Score, Pooled Cohort Equations and QRISK3. RESULTS Those with PA (n=128) and EH (n=133), did not differ significantly in their calculated CVD risks with the NVDPA algorithm (moderate-to-high 5-year risk 36/100 vs 45/99, p=0.17); the Framingham Risk Score (median 10-year risk 7.72% (4.43%-12.95%) vs 6.84% (3.85%-10.50%), p=0.14); the Pooled Cohort Equations (median 10-year risk 9.45% (4.36%-15.37%) vs 7.90% (2.09%-14.73%), p=0.07); and QRISK3 (median 10-year risk 11.31% (7.22%-20.29%) vs 12.47% (5.10%-19.93%), p=0.51). Similarities persisted on regression analyses accounting for systolic BP. CONCLUSIONS CVD risk algorithms do not reflect the increased risk of CVD in patients with PA, and likely underestimate the true risk of CVD among those with PA. Screening for PA, in addition to using the CVD risk algorithm in patients who had hypertension, may facilitate the targeted treatment of PA and minimisation of cardiovascular risk in affected individuals.
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Affiliation(s)
- Pravik Solanki
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Genevieve Gabb
- School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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13
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Menkhorst E, Zhou W, Santos L, Zhang JG, St-Pierre Y, Young MJ, Dimitriadis E. Galectin-7 dysregulates renin-angiotensin-aldosterone and NADPH oxide synthase pathways in preeclampsia. Pregnancy Hypertens 2022; 30:130-136. [PMID: 36183583 DOI: 10.1016/j.preghy.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Preeclampsia is a life-threatening disorder of pregnancy unique to humans. Poor placentation in the first trimester of pregnancy is widely accepted to be an underlying cause of preeclampsia. Galectin-7 is abnormally elevated in chorionic villous samples and serum from women that subsequently develop pre-term preeclampsia. Administration of exogenous galectin-7 to pregnant mice causes preeclampsia-like features (hypertension, proteinuria), associated with dysregulation of the renin-angiotensin system (RAS). In this study investigated the mechanism by which galectin-7 induces alterations to tissue RAS homeostasis and ROS production. We hypothesized that galectin-7 induces alterations in the production of either placental RAS or NADPH oxidases (or both) to drive the dysregulated RAS and ROS production seen in preeclampsia. STUDY DESIGN Mated female mice (n = 5-6/group) received single (embryonic day [E]12/13) or multiple (E8-12) subcutaneous injections of 400 μg/kg/day galectin-7 or vehicle control and killed on E13 or E18. Human first trimester placental villous and decidual tissue (n = 11) was cultured under 8 % oxygen with 1 µg/mL galectin-7 or vehicle control for 16 h. RESULTS Galectin-7 administration to pregnant mice impaired placental labyrinth formation, suppressed circulating aldosterone and altered placental RAS (Agt, Renin) and NADPH oxidase (Cyba, Cybb and Icam1) mRNA expression. In vitro, galectin-7 regulated human placental villous RAS (AGT) and NADPH oxidase (CYBA, ICAM1 and VCAM1) mRNA expression. CONCLUSIONS Overall, galectin-7 likely drives hypertension in preeclampsia via its direct regulation of multiple pathways associated with preeclampsia in the placenta. Galectin-7 may therefore be a therapeutic target to improve placental function and prevent preeclampsia.
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Affiliation(s)
- Ellen Menkhorst
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia; Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.
| | - Wei Zhou
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
| | - Leilani Santos
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
| | - Jian-Guo Zhang
- Walter and Eliza Hall Institute, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | | | - Morag J Young
- Baker Heart & Diabetes Institute, Prahran, VIC, Australia
| | - Evdokia Dimitriadis
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia; Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
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14
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Bienvenu LA, Bell JR, Weeks KL, Delbridge LMD, Young MJ. New Perspectives on Sex Steroid and Mineralocorticoid Receptor Signaling in Cardiac Ischemic Injury. Front Physiol 2022; 13:896425. [PMID: 35846011 PMCID: PMC9277457 DOI: 10.3389/fphys.2022.896425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
The global burden of ischemic heart disease is burgeoning for both men and women. Although advances have been made, the need for new sex-specific therapies targeting key differences in cardiovascular disease outcomes in men and women remains. Mineralocorticoid receptor directed treatments have been successfully used for blood pressure control and heart failure management and represent a potentially valuable therapeutic option for ischemic cardiac events. Clinical and experimental data indicate that mineralocorticoid excess or inappropriate mineralocorticoid receptor (MR) activation exacerbates ischemic damage, and many of the intracellular response pathways activated in ischemia and subsequent reperfusion are regulated by MR. In experimental contexts, where MR are abrogated genetically or mineralocorticoid signaling is suppressed pharmacologically, ischemic injury is alleviated, and reperfusion recovery is enhanced. In the chronic setting, mineralocorticoid signaling induces fibrosis, oxidative stress, and inflammation, which can predispose to ischemic events and exacerbate post-myocardial infarct pathologies. Whilst a range of cardiac cell types are involved in mineralocorticoid-mediated regulation of cardiac function, cardiomyocyte-specific MR signaling pathways are key. Selective inhibition of cardiomyocyte MR signaling improves electromechanical resilience during ischemia and enhances contractile recovery in reperfusion. Emerging evidence suggests that the MR also contribute to sex-specific aspects of ischemic vulnerability. Indeed, MR interactions with sex steroid receptors may differentially regulate myocardial nitric oxide bioavailability in males and females, potentially determining sex-specific post-ischemic outcomes. There is hence considerable impetus for exploration of MR directed, cell specific therapies for both women and men in order to improve ischemic heart disease outcomes.
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Affiliation(s)
- Laura A. Bienvenu
- Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne VIC, Melbourne, VIC, Australia
| | - James R. Bell
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- *Correspondence: James R. Bell,
| | - Kate L. Weeks
- Baker Department of Cardiometabolic Health, University of Melbourne VIC, Melbourne, VIC, Australia
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, Australia
| | - Lea M. D. Delbridge
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, Australia
| | - Morag J. Young
- Baker Department of Cardiometabolic Health, University of Melbourne VIC, Melbourne, VIC, Australia
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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15
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Libianto R, Russell GM, Stowasser M, Gwini SM, Nuttall P, Shen J, Young MJ, Fuller PJ, Yang J. Detecting primary aldosteronism in Australian primary care: a prospective study. Med J Aust 2022; 216:408-412. [PMID: 35218017 DOI: 10.5694/mja2.51438] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the identification of primary aldosteronism (PA) in newly diagnosed, treatment-naïve patients with hypertension by screening in primary care. DESIGN Prospective study. SETTING General practices in the South Eastern Melbourne Primary Health Network with at least three general practitioners and general practices elsewhere in Victoria that had referred patients to the Endocrine Hypertension Clinic at Monash Health, 2017-2020. PARTICIPANTS Adults (18-80 years) with newly diagnosed hypertension (measurements of systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg on at least two occasions) and not taking antihypertensive medications were screened for PA by assessing their aldosterone-to-renin ratio (ARR). Participants with two ARR values exceeding 70 pmol/mU underwent saline suppression testing at the Endocrine Hypertension Service (Monash Health) to confirm the diagnosis of PA. MAIN OUTCOME MEASURES Prevalence of PA (number of patients with confirmed PA divided by number screened). RESULTS Sixty-two of 247 screened participants had elevated ARR values on screening (25%); for 35 people (14%; 95% CI, 10-19%), PA was confirmed by saline suppression testing. Baseline characteristics (mean age, sex distribution, median baseline blood pressure levels, and serum potassium concentration) were similar for people with or without PA. CONCLUSION PA was diagnosed in 14% of patients with newly diagnosed hypertension screened by GPs, indicating a potential role for GPs in the early detection of an important form of secondary hypertension for which specific therapies are available.
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Affiliation(s)
- Renata Libianto
- Monash Health, Melbourne, VIC.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | | | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland, Brisbane, QLD
| | | | - Peta Nuttall
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Jimmy Shen
- Monash Health, Melbourne, VIC.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Peter J Fuller
- Monash Health, Melbourne, VIC.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Jun Yang
- Monash Health, Melbourne, VIC.,Monash University, Melbourne, VIC
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16
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Karthigan N, Lockwood S, White A, Yang J, Young MJ. Mineralocorticoid receptor antagonists, heart failure and predictive biomarkers. J Endocrinol 2022; 253:R65-R76. [PMID: 35266453 DOI: 10.1530/joe-21-0323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022]
Abstract
The mineralocorticoid receptor is a steroid hormone receptor that is well known for its involvement in fluid and electrolyte homeostasis in epithelial cells present in the distal nephron. The inappropriate activation of this receptor is now known to be implicated in various pathophysiological mechanisms in heart failure. Mineralocorticoid receptor antagonists offer substantial clinical benefit in patients with heart failure with reduced ejection fraction; however, for patients with heart failure with preserved ejection fraction, the treatment benefit is less clear. Biomarkers that can predict response to mineralocorticoid receptor antagonist treatment do not currently exist. Potential biomarkers may be modulated either directly by the mineralocorticoid receptor or indirectly via downstream effects and be able to reflect treatment outcomes, particularly changes in key parameters of cardiac health and function. A biomarker or set of biomarkers that can reliably predict responsiveness to mineralocorticoid receptor antagonist treatment at an early stage may allow for the selection of patients who are most likely to benefit from treatment thereby avoiding any unnecessary side effects associated with the use of these medications.
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Affiliation(s)
- Nikshay Karthigan
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Prahran, Australia
- Endocrine Hypertension Group, Hudson Institute of Medical Research, Clayton, Australia
| | - Siobhan Lockwood
- Monash Cardiovascular Research Centre, Monash Health, Clayton, Australia
- Department of Medicine, Monash University, Clayton, Australia
| | - Anthony White
- Monash Cardiovascular Research Centre, Monash Health, Clayton, Australia
- Department of Medicine, Monash University, Clayton, Australia
| | - Jun Yang
- Endocrine Hypertension Group, Hudson Institute of Medical Research, Clayton, Australia
- Department of Medicine, Monash University, Clayton, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Prahran, Australia
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17
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Lao JC, Bui CB, Pang MA, Cho SX, Rudloff I, Elgass K, Schröder J, Maksimenko A, Mangan NE, Starkey MR, Skuza EM, Sun YBY, Beker F, Collins CL, Kamlin OF, König K, Malhotra A, Tan K, Theda C, Young MJ, McLean CA, Wilson NJ, Sehgal A, Hansbro PM, Pearson JT, Polo JM, Veldman A, Berger PJ, Nold-Petry CA, Nold MF. Type 2 immune polarization is associated with cardiopulmonary disease in preterm infants. Sci Transl Med 2022; 14:eaaz8454. [PMID: 35385341 DOI: 10.1126/scitranslmed.aaz8454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Postnatal maturation of the immune system is poorly understood, as is its impact on illnesses afflicting term or preterm infants, such as bronchopulmonary dysplasia (BPD) and BPD-associated pulmonary hypertension. These are both cardiopulmonary inflammatory diseases that cause substantial mortality and morbidity with high treatment costs. Here, we characterized blood samples collected from 51 preterm infants longitudinally at five time points, 20 healthy term infants at birth and age 3 to 16 weeks, and 5 healthy adults. We observed strong associations between type 2 immune polarization in circulating CD3+CD4+ T cells and cardiopulmonary illness, with odds ratios up to 24. Maternal magnesium sulfate therapy, delayed hepatitis B vaccination, and increasing fetal, but not maternal, chorioamnionitis severity were associated with attenuated type 2 polarization. Blocking type 2 mediators such as interleukin-4 (IL-4), IL-5, IL-13, or signal transducer and activator of transcription 6 (STAT6) in murine neonatal cardiopulmonary disease in vivo prevented changes in cell type composition, increases in IL-1β and IL-13, and losses of pulmonary capillaries, but not gains in larger vessels. Thereby, type 2 blockade ameliorated lung inflammation, protected alveolar and vascular integrity, and confirmed the pathological impact of type 2 cytokines and STAT6. In-depth flow cytometry and single-cell transcriptomics of mouse lungs further revealed complex associations between immune polarization and cardiopulmonary disease. Thus, this work advances knowledge on developmental immunology and its impact on early life disease and identifies multiple therapeutic approaches that may relieve inflammation-driven suffering in the youngest patients.
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Affiliation(s)
- Jason C Lao
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Christine B Bui
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Merrin A Pang
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Steven X Cho
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Ina Rudloff
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Kirstin Elgass
- Monash Micro Imaging, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Jan Schröder
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia
| | - Anton Maksimenko
- Imaging and Medical Beamline, Australian Synchrotron, Melbourne, Victoria 3168, Australia
| | - Niamh E Mangan
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Melbourne, Victoria 3168, Australia
| | - Malcolm R Starkey
- Priority Research Centres for Healthy Lungs and GrowUpWell, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales 2308, Australia.,Department of Immunology and Pathology, Monash University, Melbourne, Victoria 3004, Australia
| | - Elisabeth M Skuza
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Yu B Y Sun
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia
| | - Friederike Beker
- Mater Research Institute, University of Queensland, Brisbane, Queensland 4101, Australia.,Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
| | - Clare L Collins
- Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
| | - Omar F Kamlin
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria 3052, Australia.,University of Melbourne, Melbourne, Victoria 3010, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Kai König
- Department of Paediatrics, Medicum Wesemlin, Lucerne 6006, Switzerland
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| | - Christiane Theda
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria 3052, Australia.,University of Melbourne, Melbourne, Victoria 3010, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Catriona A McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria 3004, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria 3800, Australia
| | - Nicholas J Wilson
- CSL Limited, Bio21 Institute, Parkville, Melbourne, Victoria 3052, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| | - Philip M Hansbro
- Priority Research Centres for Healthy Lungs and GrowUpWell, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales 2308, Australia.,Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Ultimo, Sydney, New South Wales 2007, Australia
| | - James T Pearson
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria 3800, Australia.,Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka 564-8565, Japan.,Victorian Heart Institute, Melbourne, Victoria 3168, Australia
| | - Jose M Polo
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Adelaide Centre for Epigenetics, University of Adelaide, Adelaide, South Australia 5005, Australia.,South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Alex Veldman
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Department of Pediatrics, Helios HSK, Wiesbaden 65199, Germany.,Department of Pediatric Cardiology, J. Liebig University, Gießen 35392, Germany
| | - Philip J Berger
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Claudia A Nold-Petry
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Marcel F Nold
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
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Hung CS, Chang YY, Tsai CH, Liao CW, Peng SY, Lee BC, Pan CT, Wu XM, Chen ZW, Wu VC, Wan CH, Young MJ, Chou CH, Lin YH. Aldosterone suppresses cardiac mitochondria. Transl Res 2022; 239:58-70. [PMID: 34411778 DOI: 10.1016/j.trsl.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Elevated serum aldosterone promotes arterial hypertension, cardiac hypertrophy, and diastolic dysfunction. However, the effect of elevated aldosterone levels on cardiac mitochondria remains unclear. We used primary cultures of mouse cardiomyocytes to determine whether aldosterone has direct effects on cardiomyocyte mitochondria, and aldosterone-infused mice as a preclinical model to evaluate the impact of aldosterone in vivo. We show that aldosterone suppressed mtDNA copy number and SOD2 expression via the mineralocorticoid receptor (MR)-dependent regulation of NADPH oxidase 2 (NOX2) and generation of reactive oxygen species (ROS) in primary mouse cardiomyocytes. Aldosterone suppressed cardiac mitochondria adenosine triphosphate production, which was rescued by N-acetylcysteine. Aldosterone infusion for 4 weeks in mice suppressed the number of cardiac mitochondria, mtDNA copy number, and SOD2 protein expression. MR blockade by eplerenone or the administration of N-acetylcysteine prevented aldosterone-induced cardiac mitochondrial damage in vivo. Similarly, patients with primary aldosteronism had a lower plasma leukocyte mtDNA copy number. Plasma leukocyte mtDNA copy number was positively correlated with 24-hour urinary aldosterone level and left ventricular mass index. In conclusion, aldosterone suppresses cardiac mitochondria in vivo and directly via MR activation of ROS pathways.
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Affiliation(s)
- Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Yi-Yao Chang
- Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.).
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City , Taiwan (R.O.C.).
| | - Che-Wei Liao
- Department of Medicine, National Taiwan, University Cancer Center, Taipei, Taiwan (R.O.C.).
| | - Shih-Yuan Peng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan (R.O.C.).
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, University College of Medicine, Taipei, Taoyuan City, Taiwan (R.O.C.).
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan (R.O.C.).
| | - Vin-Cent Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Cho-Hua Wan
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan (R.O.C.).
| | - Morag J Young
- Baker Heart and Diabetes Institute, Prahran, Australia.
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan.
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
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19
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Abstract
Mineralocorticoid receptor (MR) antagonists (MRA), also referred to as aldosterone blockers, are now well-recognized for their clinical benefit in patients who have heart failure (HF) with reduced ejection fraction (HFrEF). Recent studies have also shown MRA can improve outcomes in patients with HFpEF, where the ejection fraction is preserved but left ventricular filling is reduced. While the MR is a steroid hormone receptor best known for antinatriuretic actions on electrolyte homeostasis in the distal nephron, it is now established that the MR has many physiological and pathophysiological roles in the heart, vasculature, and other nonepithelial tissue types. It is the impact of MR activation on these tissues that underpins the use of MRA in cardiovascular disease, in particular HF. This mini-review will discuss the origins and the development of MRA and highlight how their use has evolved from the "potassium-sparing diuretics" spironolactone and canrenone over 60 years ago, to the more receptor-selective eplerenone and most recently the emergence of new nonsteroidal receptor antagonists esaxerenone and finerenone.
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Affiliation(s)
- Morag J Young
- Baker Heart and Diabetes Institute, Cardiovascular Endocrinology Laboratory, Prahran 3181, Australia
| | - Monica Kanki
- Baker Heart and Diabetes Institute, Cardiovascular Endocrinology Laboratory, Prahran 3181, Australia
- Hudson Institute of Medical Research, Victoria 3168, Australia
| | - Nikshay Karthigan
- Baker Heart and Diabetes Institute, Cardiovascular Endocrinology Laboratory, Prahran 3181, Australia
- Hudson Institute of Medical Research, Victoria 3168, Australia
| | - Penny Konstandopoulos
- Baker Heart and Diabetes Institute, Cardiovascular Endocrinology Laboratory, Prahran 3181, Australia
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20
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Alexander SP, Cidlowski JA, Kelly E, Mathie A, Peters JA, Veale EL, Armstrong JF, Faccenda E, Harding SD, Pawson AJ, Southan C, Davies JA, Coons L, Fuller PJ, Korach KS, Young MJ. THE CONCISE GUIDE TO PHARMACOLOGY 2021/22: Nuclear hormone receptors. Br J Pharmacol 2021; 178 Suppl 1:S246-S263. [PMID: 34529827 PMCID: PMC9513947 DOI: 10.1111/bph.15540] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Concise Guide to PHARMACOLOGY 2021/22 is the fifth in this series of biennial publications. The Concise Guide provides concise overviews, mostly in tabular format, of the key properties of nearly 1900 human drug targets with an emphasis on selective pharmacology (where available), plus links to the open access knowledgebase source of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties. Although the Concise Guide constitutes over 500 pages, the material presented is substantially reduced compared to information and links presented on the website. It provides a permanent, citable, point‐in‐time record that will survive database updates. The full contents of this section can be found at http://onlinelibrary.wiley.com/doi/bph.15540. Nuclear hormone receptors are one of the six major pharmacological targets into which the Guide is divided, with the others being: G protein‐coupled receptors, catalytic receptors, enzymes and transporters. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. The landscape format of the Concise Guide is designed to facilitate comparison of related targets from material contemporary to mid‐2021, and supersedes data presented in the 2019/20, 2017/18, 2015/16 and 2013/14 Concise Guides and previous Guides to Receptors and Channels. It is produced in close conjunction with the Nomenclature and Standards Committee of the International Union of Basic and Clinical Pharmacology (NC‐IUPHAR), therefore, providing official IUPHAR classification and nomenclature for human drug targets, where appropriate.
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Affiliation(s)
- Stephen Ph Alexander
- School of Life Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK
| | - John A Cidlowski
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, 27709, USA
| | - Eamonn Kelly
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Alistair Mathie
- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent, ME4 4TB, UK
| | - John A Peters
- Neuroscience Division, Medical Education Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - Emma L Veale
- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent, ME4 4TB, UK
| | - Jane F Armstrong
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Elena Faccenda
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Simon D Harding
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Adam J Pawson
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Christopher Southan
- Neuroscience Division, Medical Education Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - Jamie A Davies
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | | | - Peter J Fuller
- Hudson Institute of Medical Research, Clayton, Australia
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21
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Abstract
Primary aldosteronism confers a higher risk of stroke, atrial fibrillation, and cardiovascular disease than blood pressure matched essential hypertension. It is the most common endocrine cause of secondary hypertension with prevalence estimates of up to 13% in primary care and 30% in referral centers around the world. Unlike essential hypertension, primary aldosteronism has targeted medical treatment and potentially curative surgical solutions which can ameliorate the associated cardiovascular risks. This narrative review highlights an evidence gap in the optimal diagnosis and targeted treatment of primary aldosteronism in secondary stroke prevention. Over half of the patients suffering a stroke have blood pressure in the hypertensive range and less than a third achieve optimal blood pressure control. There are no guideline recommendations to test for primary aldosteronism in these patients, although up to 30% of patients with resistant hypertension may have this disease. The accurate diagnosis of primary aldosteronism could significantly improve blood pressure, simplify the medication regimen and reduce the overall cardiovascular risk in these patients. The challenges associated with screening for primary aldosteronism following stroke may be overcome by novel blood tests which are less affected by antihypertensive medications routinely used in stroke care. Approximately one-quarter of all strokes occur in patients who have previously had a stroke. Modifying hypertension, the leading modifiable risk factor, would, therefore, have significant public health implications. As clinicians, we must increase our awareness of primary aldosteronism in patients with stroke, particularly in those with resistant hypertension, to enable targeted therapy and reduce the risk of stroke recurrence.
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Affiliation(s)
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia (J.Y., M.J.Y., P.J.F.).,Departments of Endocrinology (J.Y., P.J.F.), Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (J.Y., B.C., T.P.)
| | - Ben Clissold
- Neurology (B.C., T.P.), Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (J.Y., B.C., T.P.)
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia (J.Y., M.J.Y., P.J.F.).,Baker Heart and Diabetes Institute, Melbourne, Australia (M.J.Y.)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia (J.Y., M.J.Y., P.J.F.).,Departments of Endocrinology (J.Y., P.J.F.), Monash Health, Clayton, Australia
| | - Thanh Phan
- Neurology (B.C., T.P.), Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (J.Y., B.C., T.P.)
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22
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Lim YY, Libianto R, Shen J, Young MJ, Fuller PJ, Yang J. Impact of Victoria's first dedicated endocrine hypertension service on the pattern of primary aldosteronism diagnoses. Intern Med J 2021; 51:1255-1261. [DOI: 10.1111/imj.14879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yin Yu Lim
- Department of Endocrinology Monash Health Melbourne Victoria Australia
- School of Clinical Sciences Monash University Melbourne Victoria Australia
| | - Renata Libianto
- Department of Endocrinology Monash Health Melbourne Victoria Australia
- Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Melbourne Victoria Australia
| | - Jimmy Shen
- School of Clinical Sciences Monash University Melbourne Victoria Australia
- Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Melbourne Victoria Australia
| | - Morag J. Young
- Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Melbourne Victoria Australia
| | - Peter J. Fuller
- Department of Endocrinology Monash Health Melbourne Victoria Australia
- Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Melbourne Victoria Australia
| | - Jun Yang
- Department of Endocrinology Monash Health Melbourne Victoria Australia
- School of Clinical Sciences Monash University Melbourne Victoria Australia
- Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Melbourne Victoria Australia
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23
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Yang J, May Gwini S, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori TA. Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study. Hypertension 2021; 78:387-396. [PMID: 34120455 DOI: 10.1161/hypertensionaha.121.17336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y., P.J.F.).,Department of Medicine (J.Y.), Monash University, Clayton, Victoria, Australia
| | - Stella May Gwini
- Department of Epidemiology, School of Public Health and Preventive Medicine (S.M.G.), Monash University, Clayton, Victoria, Australia.,University Hospital Geelong, Barwon Health, Victoria, Australia (S.M.G.)
| | - Lawrence J Beilin
- Medical School, The University of Western Australia (L.J.B., T.A.M.)
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia, Royal Perth Hospital Campus (M. Schlaich).,Departments of Cardiology and Nephrology, Royal Perth Hospital, Australia (M. Schlaich).,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M. Schlaich)
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia (M. Stowasser)
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Victoria, Australia (M.J. Young)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y., P.J.F.)
| | - Trevor A Mori
- Medical School, The University of Western Australia (L.J.B., T.A.M.)
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24
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Yang J, Gwini S, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori T. The Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study. J Endocr Soc 2021. [PMCID: PMC8089744 DOI: 10.1210/jendso/bvab048.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Hypertension tracks throughout childhood into adulthood. Aldosterone excess, or primary aldosteronism, has been reported as the most common secondary cause of hypertension in adults. Elevated aldosterone in the setting of low renin predicts incident hypertension in normotensive adults. However, the relationship between aldosterone and blood pressure in adolescents and young adults is unclear. Objectives: To evaluate the relationship between aldosterone, renin and the aldosterone:renin ratio (ARR) and blood pressure (BP) at age 17y as well as BP at age 27y in a community-based population. Methods: This is a prospective birth cohort study. Young adult offspring (Gen2) of women enrolled during pregnancy into the Raine Study, with 1239 at age 17y and 1006 at age 27y, were evaluated. Females taking hormonal contraception and participants without BP data were excluded from the current analysis. A generalised linear model was used to examine the relationship between BP and aldosterone, renin and ARR over time. The median aldosterone, renin and ARR was compared between sexes using quantile regression. Results: At 17y, females had similar aldosterone (349 vs 346 pmol/L, p=0.833) but significantly lower renin (20.6 vs 25.7 mU/L, p<0.001) and thus a higher ARR (18.3 vs 13.5, p<0.001) compared to males. However, they had lower systolic BP (109 vs 118 mmHg, p< 0.001) versus males. A significant correlation between ARR and systolic BP was detected in 17y males when adjusted for alcohol consumption, physical activity, urinary sodium and body mass index. This was true when the ARR was expressed as a continuous variable (β-coefficient 0.1, p=0.009) or categorical variable (highest quartile, β-coefficient 3.15, p=0.003). A similar correlation was not observed in females at 17y. However, the ARR at 17y was significantly associated with both systolic (β-coefficient 0.15, p=0.009) and diastolic BP (β-coefficient 0.14, p=0.003) at 27y in females, but not males. Conclusion: A relationship between ARR and BP are observed at both 17 and 27 years but with distinct age-related sex differences. Further evaluation of the relationship between ARR and surrogate markers of cardiovascular disease such as vascular reactivity will improve our understanding of aldosterone as a cardiovascular risk factor young people.
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Affiliation(s)
- Jun Yang
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | | | | | | | | | - Morag J Young
- Baker Heart and Diabetes Institute, Melborne, Australia
| | | | - Trevor Mori
- The University of Western Australia, Perth, Australia
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25
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Chee MR, Hoo J, Libianto R, Gwini SM, Hamilton G, Narayan O, Young MJ, Fuller PJ, Yang J. Prospective Screening for Primary Aldosteronism in Patients With Suspected Obstructive Sleep Apnea. Hypertension 2021; 77:2094-2103. [PMID: 33896193 DOI: 10.1161/hypertensionaha.120.16902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Min Ru Chee
- Department of Endocrinology (M.R.C., J.H., R.L., P.J.F., J.Y.), Monash Health, Clayton, Victoria, Australia.,Department of Medicine, School of Clinical Sciences (M.R.C., J.H., R.L., G.H., J.Y.), Monash University, Melbourne, Victoria, Australia
| | - Jesse Hoo
- Department of Endocrinology (M.R.C., J.H., R.L., P.J.F., J.Y.), Monash Health, Clayton, Victoria, Australia.,Department of Medicine, School of Clinical Sciences (M.R.C., J.H., R.L., G.H., J.Y.), Monash University, Melbourne, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology (M.R.C., J.H., R.L., P.J.F., J.Y.), Monash Health, Clayton, Victoria, Australia.,Department of Medicine, School of Clinical Sciences (M.R.C., J.H., R.L., G.H., J.Y.), Monash University, Melbourne, Victoria, Australia.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (R.L., M.J.Y., P.J.F., J.Y.)
| | - Stella M Gwini
- School of Public Health and Preventive Medicine (S.M.G.), Monash University, Melbourne, Victoria, Australia.,University Hospital Geelong, Barwon Health, Victoria, Australia (S.M.G.)
| | - Garun Hamilton
- Department of Lung and Sleep Medicine (G.H.), Monash Health, Clayton, Victoria, Australia.,Department of Medicine, School of Clinical Sciences (M.R.C., J.H., R.L., G.H., J.Y.), Monash University, Melbourne, Victoria, Australia
| | - Om Narayan
- MonashHeart (O.N.), Monash Health, Clayton, Victoria, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (R.L., M.J.Y., P.J.F., J.Y.).,Baker Heart and Diabetes Institute, Prahran, Australia (M.J.Y.)
| | - Peter J Fuller
- Department of Endocrinology (M.R.C., J.H., R.L., P.J.F., J.Y.), Monash Health, Clayton, Victoria, Australia.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (R.L., M.J.Y., P.J.F., J.Y.)
| | - Jun Yang
- Department of Endocrinology (M.R.C., J.H., R.L., P.J.F., J.Y.), Monash Health, Clayton, Victoria, Australia.,Department of Medicine, School of Clinical Sciences (M.R.C., J.H., R.L., G.H., J.Y.), Monash University, Melbourne, Victoria, Australia.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (R.L., M.J.Y., P.J.F., J.Y.)
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26
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Barros ER, Rigalli JP, Tapia-Castillo A, Vecchiola A, Young MJ, Hoenderop JGJ, Bindels RJM, Fardella CE, Carvajal CA. Proteomic Profile of Urinary Extracellular Vesicles Identifies AGP1 as a Potential Biomarker of Primary Aldosteronism. Endocrinology 2021; 162:6134351. [PMID: 33580265 DOI: 10.1210/endocr/bqab032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Primary aldosteronism (PA) represents 6% to 10% of all essential hypertension patients and is diagnosed using the aldosterone-to-renin ratio (ARR) and confirmatory studies. The complexity of PA diagnosis encourages the identification of novel PA biomarkers. Urinary extracellular vesicles (uEVs) are a potential source of biomarkers, considering that their cargo reflects the content of the parent cell. OBJECTIVE We aimed to evaluate the proteome of uEVs from PA patients and identify potential biomarker candidates for PA. METHODS Second morning spot urine was collected from healthy controls (n = 8) and PA patients (n = 7). The uEVs were isolated by ultracentrifugation and characterized. Proteomic analysis on uEVs was performed using LC-MS Orbitrap. RESULTS Isolated uEVs carried extracellular vesicle markers, showed a round shape and sizes between 50 and 150 nm. The concentration of uEVs showed a direct correlation with urinary creatinine (r = 0.6357; P = 0.0128). The uEV size mean (167 ± 6 vs 183 ± 4nm) and mode (137 ± 7 vs 171 ± 11nm) was significantly smaller in PA patients than in control subjects, but similar in concentration. Proteomic analysis of uEVs from PA patients identified an upregulation of alpha-1-acid glycoprotein 1 (AGP1) in PA uEVs, which was confirmed using immunoblot. A receiver operating characteristic curve analysis showed an area under the curve of 0.92 (0.82 to 1; P = 0.0055). CONCLUSION Proteomic and further immunoblot analyses of uEVs highlights AGP1 as potential biomarker for PA.
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Affiliation(s)
- Eric R Barros
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
- Center for Translational Research in Endocrinology (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Rigalli
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Alejandra Tapia-Castillo
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Research in Endocrinology (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
| | - Andrea Vecchiola
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Research in Endocrinology (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
| | - Morag J Young
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Joost G J Hoenderop
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - René J M Bindels
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Research in Endocrinology (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
| | - Cristian A Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Research in Endocrinology (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
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27
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Burke SL, Barzel B, Jackson KL, Gueguen C, Young MJ, Head GA. Role of Mineralocorticoid and Angiotensin Type 1 Receptors in the Paraventricular Nucleus in Angiotensin-Induced Hypertension. Front Physiol 2021; 12:640373. [PMID: 33762970 PMCID: PMC7982587 DOI: 10.3389/fphys.2021.640373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
The hypothalamic paraventricular nucleus (PVN) is an important site where an interaction between circulating angiotensin (Ang) and mineralocorticoid receptor (MR) activity may modify sympathetic nerve activity (SNA) to influence long-term elevation of blood pressure. We examined in conscious Ang II-treated rabbits, the effects on blood pressure and tonic and reflex renal SNA (RSNA) of microinjecting into the PVN either RU28318 to block MR, losartan to block Ang (AT1) receptors or muscimol to inhibit GABAA receptor agonist actions. Male rabbits received a moderate dose of Ang II (24 ng/kg/min subcutaneously) for 3 months (n = 13) or sham treatment (n = 13). At 3 months, blood pressure increased by +19% in the Ang II group compared to 10% in the sham (P = 0.022) but RSNA was similar. RU28318 lowered blood pressure in both Ang II and shams but had a greater effect on RSNA and heart rate in the Ang II-treated group (P < 0.05). Losartan also lowered RSNA, while muscimol produced sympatho-excitation in both groups. In Ang II-treated rabbits, RU28318 attenuated the blood pressure increase following chemoreceptor stimulation but did not affect responses to air jet stress. In contrast losartan and muscimol reduced blood pressure and RSNA responses to both hypoxia and air jet. While neither RU28318 nor losartan changed the RSNA baroreflex, RU28318 augmented the range of the heart rate baroreflex by 10% in Ang II-treated rabbits. Muscimol, however, augmented the RSNA baroreflex by 11% in sham animals and none of the treatments altered baroreflex sensitivity. In conclusion, 3 months of moderate Ang II treatment promotes activation of reflex RSNA principally via MR activation in the PVN, rather than via activation of AT1 receptors. However, the onset of hypertension is independent of both. Interestingly, the sympatho-excitatory effects of muscimol in both groups suggest that overall, the PVN regulates a tonic sympatho-inhibitory influence on blood pressure control.
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Affiliation(s)
- Sandra L Burke
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Benjamin Barzel
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kristy L Jackson
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Cindy Gueguen
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Geoffrey A Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Pharmacology, Monash University, Clayton, VIC, Australia
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Libianto R, Menezes S, Kaur A, Gwini SM, Shen J, Narayan O, Fuller PJ, Yang J, Young MJ. Comparison of ambulatory blood pressure between patients with primary aldosteronism and other forms of hypertension. Clin Endocrinol (Oxf) 2021; 94:353-360. [PMID: 33270939 DOI: 10.1111/cen.14373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure-matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end-organ damage. However, PA is currently substantially under-diagnosed. The standard screening test for PA, the aldosterone-to-renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening. STUDY DESIGN Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM. RESULTS In this study, PA patients were younger and had higher 24-h, day, and night-time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day-night blood pressure variability between the two groups. CONCLUSIONS An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.
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Affiliation(s)
- Renata Libianto
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Department of Medicine, Monash University, Clayton, Vic, Australia
| | - Serena Menezes
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Amrina Kaur
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Stella May Gwini
- Barwon Health, University Hospital Geelong, Geelong, Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jimmy Shen
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
| | - Om Narayan
- MonashHeart, Monash Health, Clayton, Vic, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Department of Medicine, Monash University, Clayton, Vic, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Medicine, Monash University, Clayton, Vic, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Young MJ, Kanki M, Fuller PJ, Yang J. Identifying new cellular mechanisms of mineralocorticoid receptor activation in the heart. J Hum Hypertens 2021; 35:124-130. [PMID: 32733061 DOI: 10.1038/s41371-020-0386-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 01/30/2023]
Abstract
Recent studies have expanded our understanding of the actions of the mineralocorticoid receptor (MR) to a diverse array of tissue types that differ substantially from the epithelial cells of the renal nephron. In these cell types the role of the MR has been largely, but not exclusively, defined in terms of pathogenic signalling pathways leading to tissue injury and remodelling. Macrophages and cardiomyocytes are two cell types in which the MR plays a central role in the cardiac tissue response to injury, renovascular hypertension and oxidative stress for example. Macrophages are critical for resolution of tissue injury and wound healing and their pleiotropic actions are central to the development of many forms of heart, renal and vascular disease. The MR in cardiomyocytes is not only essential for the chronotropic and ionotropic actions of mineralocorticoids in the short and longer term, but also for induction of hypertrophic and proinflammatory signalling programs. The present review discusses recent studies, presented at the Aldosterone and Hypertension Satellite of the 15th Asian-Pacific Congress of Hypertension, investigating new mechanisms for MR signalling in these cells and how their dysfunction contributes to the onset and progression of cardiovascular disease and heart failure.
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Affiliation(s)
- Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia. .,Baker Heart and Diabetes Institute, Melborne, VIC, Australia.
| | - Monica Kanki
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia.,Baker Heart and Diabetes Institute, Melborne, VIC, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia
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30
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Libianto R, Hu J, Chee MR, Hoo J, Lim YY, Shen J, Li Q, Young MJ, Fuller PJ, Yang J. A Multicenter Study of Neutrophil-to-Lymphocyte Ratio in Primary Aldosteronism. J Endocr Soc 2020; 4:bvaa153. [PMID: 33225198 PMCID: PMC7667995 DOI: 10.1210/jendso/bvaa153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 12/28/2022] Open
Abstract
Background Hypertensive patients with primary aldosteronism (PA) have a higher risk of cardiovascular complications than those with blood pressure-matched essential hypertension. The excess cardiovascular consequences of PA can be attributed to the proinflammatory effect of excessive aldosterone and mineralocorticoid receptor activation in a range of peripheral tissues and cell types. The neutrophil-to-lymphocyte ratio (NLR) is a widely available marker of inflammation which has been shown to predict cardiovascular outcome in the general population. This study aims to evaluate the use of NLR as a potential biomarker of PA and PA severity. Methods Patients with PA (n = 355) were identified from 2 large PA databases in Australia and China, while controls (n = 222) were patients with hypertension who were referred for assessment but did not meet the diagnostic criteria for PA. The NLR was retrospectively collected from routine full blood examination, prior to commencement of targeted treatment for PA. Results The NLR did not differ between PA patients and hypertensive controls (median 2.3 and 2.4, P = 0.563). However, among patients with PA, the NLR was positively correlated with baseline and post-saline aldosterone levels (r = 0.22 and P < 0.001 for both) and negatively correlated with serum potassium (r = -0.15, P = 0.006). Furthermore, in a logistic regression analysis of data from patients with PA, the NLR predicted the presence of comorbid chronic kidney disease (CKD) (defined as estimated glomerular filtration rate <60 mL/min/1.73m2) with an odds ratio of 1.5 (P = 0.003). Conclusion While the NLR did not distinguish PA from controls, it was a marker of PA severity, being associated with aldosterone concentration as well as the presence of CKD. A prospective study is needed to further clarify the role of NLR in predicting end-organ damage associated with PA.
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Affiliation(s)
- Renata Libianto
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min R Chee
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jesse Hoo
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Yin Y Lim
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jimmy Shen
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Prahan, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
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Kanki M, Young MJ. Corticosteroids and circadian rhythms in the cardiovascular system. Curr Opin Pharmacol 2020; 57:21-27. [PMID: 33207294 DOI: 10.1016/j.coph.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
The mineralocorticoid receptor (MR) plays a central role in cardiac physiological function and disease and is thus an attractive therapeutic target for patients with heart failure. However, the incidence of significant side effects from mineralocorticoid receptor antagonist (MRA) treatment has led to investigation of new mechanisms that may enhance MR targeted therapies. Recent studies have identified the circadian clock as a novel, reciprocal interacting partner of the MR in the heart. While the closely related glucocorticoid receptor (GR) and its ligand, cortisol (corticosterone in rodents), are established regulators of the circadian clock, new data suggest that the MR can also regulate circadian clock gene expression and timing. This review will discuss the role of the MR and its ligands in the regulation of the circadian clock in the heart and the implications of dysregulation of these systems for cardiac disease progression, and for MR activation.
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Affiliation(s)
- Monica Kanki
- Cardiovascular Endocrinology Laboratory, Baker Heart & Diabetes Institute, Melbourne, VIC, Australia; Cardiovascular Endocrinology Laboratory, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular & Translational Science, Monash University, Clayton, VIC, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart & Diabetes Institute, Melbourne, VIC, Australia; Cardiovascular Endocrinology Laboratory, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular & Translational Science, Monash University, Clayton, VIC, Australia; Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia.
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32
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Cohen J, Bellomo R, Billot L, Burrell LM, Evans DM, Finfer S, Hammond NE, Li Q, Liu D, McArthur C, McWhinney B, Moore J, Myburgh J, Peake S, Pretorius C, Rajbhandari D, Rhodes A, Saxena M, Ungerer JPJ, Young MJ, Venkatesh B. Plasma Cortisol, Aldosterone, and Ascorbic Acid Concentrations in Patients with Septic Shock Do Not Predict Treatment Effect of Hydrocortisone on Mortality. A Nested Cohort Study. Am J Respir Crit Care Med 2020; 202:700-707. [PMID: 32396775 DOI: 10.1164/rccm.202002-0281oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Rationale: Whether biomarkers can identify subgroups of patients with septic shock with differential treatment responses to hydrocortisone is unknown.Objectives: To determine if there is heterogeneity in effect for hydrocortisone on mortality, shock resolution, and other clinical outcomes based on baseline cortisol, aldosterone, and ascorbic acid concentrations.Methods: From May 2014 to April 2017, we obtained serum samples from 529 patients with septic shock from 22 ICUs in Australia and New Zealand.Measurements and Main Results: There were no significant interactions between the association with 90-day mortality and treatment with either hydrocortisone or placebo for total cortisol (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.16 vs. OR, 1.07; 95% CI, 1.00-1.13; P = 0.70), free cortisol (OR, 1.20; 95% CI, 1.04-1.38 vs. OR, 1.16; 95% CI, 1.02-1.32; P = 0.75), aldosterone (OR, 1.01; 95% CI, 0.97-1.05 vs. OR, 1.01; 95% CI, 0.98-1.04; P = 0.99), or ascorbic acid (OR, 1.11; 95% CI, 0.89-1.39 vs. OR, 1.05; 95% CI, 0.91-1.22; P = 0.70), respectively. Similar results were observed for the association with shock resolution. Elevated free cortisol was significantly associated with 90-day mortality (OR, 1.13; 95% CI, 1.00-1.27; P = 0.04), but total cortisol, aldosterone, and ascorbic acid were not.Conclusions: In patients with septic shock, there was no heterogeneity in effect of adjunctive hydrocortisone on mortality, shock resolution, or other clinical outcomes based on cortisol, aldosterone, and ascorbic acid concentrations. Plasma aldosterone and ascorbic acid concentrations are not associated with outcome.
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Affiliation(s)
- Jeremy Cohen
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Royal Brisbane Clinical Unit.,The Wesley Hospital, Brisbane, Queensland, Australia
| | | | - Laurent Billot
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and
| | - Louise M Burrell
- Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - David M Evans
- Diamantina Institute, and.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Simon Finfer
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Qiang Li
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - David Liu
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - John Moore
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - John Myburgh
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and.,St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Sandra Peake
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia.,Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Manoj Saxena
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | | | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, Sydney, New South Wales, Australia.,The Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,The Wesley Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and
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33
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Doan TB, Cheung V, Clyne CD, Hilton HN, Eriksson N, Young MJ, Funder JW, Muscat GEO, Fuller PJ, Clarke CL, Graham JD. A tumour suppressive relationship between mineralocorticoid and retinoic acid receptors activates a transcriptional program consistent with a reverse Warburg effect in breast cancer. Breast Cancer Res 2020; 22:122. [PMID: 33148314 PMCID: PMC7641839 DOI: 10.1186/s13058-020-01355-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/13/2020] [Indexed: 03/11/2023] Open
Abstract
Background The role of nuclear receptors in both the aetiology and treatment of breast cancer is exemplified by the use of the oestrogen receptor (ER) as a prognostic marker and treatment target. Treatments targeting the oestrogen signalling pathway are initially highly effective for most patients. However, for the breast cancers that fail to respond, or become resistant, to current endocrine treatments, the long-term outlook is poor. ER is a member of the nuclear receptor superfamily, comprising 48 members in the human, many of which are expressed in the breast and could be used as alternative targets in cases where current treatments are ineffective. Methods We used sparse canonical correlation analysis to interrogate potential novel nuclear receptor expression relationships in normal breast and breast cancer. These were further explored using whole transcriptome profiling in breast cancer cells after combinations of ligand treatments. Results Using this approach, we discovered a tumour suppressive relationship between the mineralocorticoid receptor (MR) and retinoic acid receptors (RAR), in particular RARβ. Expression profiling of MR expressing breast cancer cells revealed that mineralocorticoid and retinoid co-treatment activated an expression program consistent with a reverse Warburg effect and growth inhibition, which was not observed with either ligand alone. Moreover, high expression of both MR and RARB was associated with improved breast cancer-specific survival. Conclusion Our study reveals a previously unknown relationship between MR and RAR in the breast, which is dependent on menopausal state and altered in malignancy. This finding identifies potential new targets for the treatment of breast cancers that are refractory to existing therapeutic options. Supplementary information Supplementary information accompanies this paper at 10.1186/s13058-020-01355-x.
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Affiliation(s)
- Tram B Doan
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, PO Box 412, Westmead, NSW, 2145, Australia.
| | - Vanessa Cheung
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Colin D Clyne
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Heidi N Hilton
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, PO Box 412, Westmead, NSW, 2145, Australia
| | - Natalie Eriksson
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - John W Funder
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - George E O Muscat
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Christine L Clarke
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, PO Box 412, Westmead, NSW, 2145, Australia
| | - J Dinny Graham
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, PO Box 412, Westmead, NSW, 2145, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Westmead, NSW, 2145, Australia
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Abstract
Coronavirus disease (COVID-19) is caused by a new strain of coronavirus, the severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2. At the time of writing, SARS-CoV-2 has infected over 5 million people worldwide. A key step in understanding the pathobiology of the SARS-CoV-2 was the identification of -converting enzyme 2 (ACE2) as the receptor for SARS-CoV-2 to gain entry into host cells. ACE2 is an established component of the 'protective arm' of the renin-angiotensin-aldosterone-system (RAAS) that opposes ACE/angiotensin II (ANG II) pressor and tissue remodelling actions. Identification of ACE2 as the entry point for SARS-CoV-2 into cells quickly focused attention on the use of ACE inhibitors (ACEi), angiotensin receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA) in patients with hypertension and cardiovascular disease given that these pharmacological agents upregulate ACE2 expression in target cells. ACE2 is cleaved from the cells by metalloproteases ADAM10 and ADAM17. Steroid hormone receptors regulate multiple components of the RAAS and may contribute to the observed variation in the incidence of severe COVID-19 between men and women, and in patients with pre-existing endocrine-related disease. Moreover, glucocorticoids play a critical role in the acute and chronic management of inflammatory disease, independent of any effect on RAAS activity. Dexamethasone, a synthetic glucocorticoid, has emerged as a life-saving treatment in severe COVID-19. This review will examine the endocrine mechanisms that control ACE2 and discusses the impact of therapies targeting the RAAS, glucocorticoid and other endocrine systems for their relevance to the impact of SARS-CoV-2 infection and the treatment and recovery from COVID-19-related critical illness.
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Affiliation(s)
- Morag J Young
- Baker Heart and Diabetes Institute, Prahran, Australia
- Hudson Institute of Medical Research, Clayton, Australia
| | - Colin D Clyne
- Hudson Institute of Medical Research, Clayton, Australia
| | - Karen E Chapman
- The University/BHF Centre for Cardiovascular Science, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
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Chee NYN, Abdul-Wahab A, Libianto R, Gwini SM, Doery JCG, Choy KW, Chong W, Lau KK, Lam Q, MacIsaac RJ, Chiang C, Shen J, Young MJ, Fuller PJ, Yang J. Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization. Clin Endocrinol (Oxf) 2020; 93:394-403. [PMID: 32403203 DOI: 10.1111/cen.14220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adrenal vein sampling (AVS) is crucial for accurate lateralization of aldosterone excess but it is technically challenging due to the difficulty of adrenal vein cannulation. The use of adrenocorticotropic hormone (ACTH) to improve cannulation success is controversial and can lead to discordant lateralization outcomes. OBJECTIVE To evaluate the utility of ACTH in two centres with different levels of AVS expertise and formulate a strategy for interpreting discordant results. DESIGN A retrospective cross-sectional analysis of AVS results and postoperative patient outcomes. SETTING Two large tertiary hospitals with harmonized AVS protocols where adrenal venous samples are collected both before and after ACTH stimulation. MEASUREMENTS Cannulation success (measured by selectivity index, SI), lateralization (measured by lateralization index, LI) and postoperative biochemical cure. RESULTS Number of AVS procedures judged to have successful bilateral adrenal vein cannulation increased from 53% pre- to 73% post-ACTH. The increase in cannulation success was significantly higher in centre where AVS was performed by multiple radiologists with a lower basal success rate. In both centres, the proportion of cases deemed to display lateralization significantly decreased with the use of ACTH (70% pre- to 52% post-ACTH). Based on postoperative outcomes of patients with discordant results who underwent unilateral adrenalectomy, the combination of LI >3 pre-ACTH and LI >2 post-ACTH was predictive of a biochemical cure. CONCLUSION Adrenocorticotropic hormone can increase the rate of cannulation success during AVS at the expense of reduced lateralization. The criteria for lateralization should be carefully determined based on local data when ACTH is used.
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Affiliation(s)
- Nicholas Y N Chee
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Azni Abdul-Wahab
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stella May Gwini
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kay Weng Choy
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Winston Chong
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kenneth K Lau
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Que Lam
- Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Cherie Chiang
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
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36
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Solanki P, Gwini SM, Doery JCG, Choy KW, Shen J, Young MJ, Fuller PJ, Yang J. Age- and sex-specific reference ranges are needed for the aldosterone/renin ratio. Clin Endocrinol (Oxf) 2020; 93:221-228. [PMID: 32306417 DOI: 10.1111/cen.14199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Current Endocrine Society Clinical Practice Guidelines use a specific aldosterone/renin ratio (ARR) threshold to screen for primary aldosteronism (a treatable disease causing up to 15% of hypertension in primary care) in all patients. We sought to characterize demographic variations in the ARR, hypothesizing a need for age- and sex-specific reference ranges to improve the accuracy of the test. DESIGN Retrospective cross-sectional analysis of ARR measurements at a single tertiary hospital from December 2016 to June 2018. PATIENTS A total of 442 patients with clinically indicated ARR were included, after excluding those who were on spironolactone or the oral contraceptive pill, were pregnant or had an existing adrenal condition. MEASUREMENTS Aldosterone, renin and the ARR. RESULTS Among those aged 20-39 years (n = 74), females had significantly higher median aldosterone (369 vs 244 pmol/L, P = .028), lower median renin (17.0 vs 27.6 mIU/L, P = .034) and higher median ARR (20.7 vs 10.3 (pmol/L)/(mIU/L), P = .001) than males, despite having lower systolic (135 vs 145 mmHg, P = .021) and diastolic (89 vs 96.5 mmHg, P = .007) blood pressure. The ≥ 60-year age group (n = 157) also had significant sex differences in the ARR. With increasing age (20-39 vs ≥ 60 years), there was a significant fall in plasma aldosterone in females (369 pmol/L vs 264 pmol/L, P = .005), with no change observed in males. CONCLUSIONS For those 20-39 years old, aldosterone and the ARR are significantly higher in females despite a lower systolic and diastolic BP, highlighting the potential for false-positive results. Our findings indicate the need for prospective studies with a control population to define age- and sex-specific ARR reference ranges.
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Affiliation(s)
- Pravik Solanki
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Stella May Gwini
- Barwon Health, University Hospital Geelong, Geelong, Vic., Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Kay Weng Choy
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
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Menkhorst E, Zhou W, Santos LL, Delforce S, So T, Rainczuk K, Loke H, Syngelaki A, Varshney S, Williamson N, Pringle K, Young MJ, Nicolaides KH, St-Pierre Y, Dimitriadis E. Galectin-7 Impairs Placentation and Causes Preeclampsia Features in Mice. Hypertension 2020; 76:1185-1194. [PMID: 32862708 DOI: 10.1161/hypertensionaha.120.15313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Preeclampsia is a serious pregnancy-induced disorder unique to humans. The etiology of preeclampsia is poorly understood; however, poor placental formation is thought causal. Galectin-7 is produced by trophoblast and is elevated in first-trimester serum of women who subsequently develop preeclampsia. We hypothesized that elevated placental galectin-7 may be causative of preeclampsia. Here, we demonstrated increased galectin-7 production in chorionic villous samples from women who subsequently develop preterm preeclampsia compared with uncomplicated pregnancies. In vitro, galectin-7 impaired human first-trimester trophoblast outgrowth, increased placental production of the antiangiogenic sFlt-1 splice variant, sFlt-1-e15a, and reduced placental production and secretion of ADAM12 (a disintegrin and metalloproteinase12) and angiotensinogen. In vivo, galectin-7 administration (E8-E12) to pregnant mice caused elevated systolic blood pressure, albuminuria, impaired placentation (reduced labyrinth vascular branching, impaired decidual spiral artery remodeling, and a proinflammatory placental state demonstrated by elevated IL1β, IL6 and reduced IL10), and dysregulated expression of renin-angiotensin system components in the placenta, decidua, and kidney, including angiotensinogen, prorenin, and the angiotensin II type 1 receptor. Collectively, this study demonstrates that elevated galectin-7 during placental formation contributes to abnormal placentation and suggests that it leads to the development of preeclampsia via altering placental production of sFlt-1 and renin-angiotensin system components. Targeting galectin-7 may be a new treatment option for preeclampsia.
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Affiliation(s)
- Ellen Menkhorst
- From the Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia (E.M., K.R., H.L., E.D.)
| | - Wei Zhou
- From the Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.)
| | - Leilani L Santos
- From the Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.)
| | - Sarah Delforce
- School of Biomedical Sciences and Pharmacy (S.D., K.P.), University of Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Sciences (S.D., K.P.), University of Newcastle, NSW, Australia.,Pregnancy and Reproduction Program, Hunter Medical Research Institute, Newcastle, NSW, Australia (S.D., K.P.)
| | - Teresa So
- From the Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.)
| | - Kate Rainczuk
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia (E.M., K.R., H.L., E.D.)
| | - Hannah Loke
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia (E.M., K.R., H.L., E.D.)
| | - Argyro Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (A.S., K.H.N.)
| | - Swati Varshney
- Melbourne Mass Spectrometry and Proteomics Facility, Bio21 Molecular Science & Biotechnology Institute, The University of Melbourne, VIC, Australia (S.V., N.W.)
| | - Nicholas Williamson
- Melbourne Mass Spectrometry and Proteomics Facility, Bio21 Molecular Science & Biotechnology Institute, The University of Melbourne, VIC, Australia (S.V., N.W.)
| | - Kirsty Pringle
- School of Biomedical Sciences and Pharmacy (S.D., K.P.), University of Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Sciences (S.D., K.P.), University of Newcastle, NSW, Australia.,Pregnancy and Reproduction Program, Hunter Medical Research Institute, Newcastle, NSW, Australia (S.D., K.P.)
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (M.J.Y.).,Baker Heart & Diabetes Institute, Prahran, VIC, Australia (M.J.Y.)
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (A.S., K.H.N.)
| | - Yves St-Pierre
- INRS-Institut Armand-Frappier, Laval, QC, Canada (Y.S.-P.)
| | - Eva Dimitriadis
- From the Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia (E.M., W.Z., L.L.S., T.S., E.D.).,Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia (E.M., K.R., H.L., E.D.).,Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia (E.D.)
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Ong GSY, Cole TJ, Tesch GH, Morgan J, Dowling JK, Mansell A, Fuller PJ, Young MJ. Novel mineralocorticoid receptor mechanisms regulate cardiac tissue inflammation in male mice. J Endocrinol 2020; 246:123-134. [PMID: 32464598 DOI: 10.1530/joe-20-0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022]
Abstract
MR activation in macrophages is critical for the development of cardiac inflammation and fibrosis. We previously showed that MR activation modifies macrophage pro-inflammatory signalling, changing the cardiac tissue response to injury via both direct gene transcription and JNK/AP-1 second messenger pathways. In contrast, MR-mediated renal electrolyte homeostasis is critically determined by DNA-binding-dependent processes. Hence, ascertaining the relative contribution of MR actions via DNA binding or alternative pathways on macrophage behaviour and cardiac inflammation may provide therapeutic opportunities which separate the cardioprotective effects of MR antagonists from their undesirable renal potassium-conserving effects. We developed new macrophage cell lines either lacking MR or harbouring a mutant MR incapable of DNA binding. Western blot analysis demonstrated that MR DNA binding is required for lipopolysaccharide (LPS), but not phorbol 12-myristate-13-acetate (PMA), induction of the MAPK/pJNK pathway in macrophages. Quantitative RTPCR for pro-inflammatory and pro-fibrotic targets revealed subsets of LPS- and PMA-induced genes that were either enhanced or repressed by the MR via actions that do not always require direct MR-DNA binding. Analysis of the MR target gene and profibrotic factor MMP12 identified promoter elements that are regulated by combined MR/MAPK/JNK signalling. Evaluation of cardiac tissue responses to an 8-day DOC/salt challenge in mice selectively lacking MR DNA-binding in macrophages demonstrated levels of inflammatory markers equivalent to WT, indicating non-DNA binding-dependent MR signalling in macrophages is sufficient for DOC/salt-induced tissue inflammation. Our data demonstrate that the MR regulates a macrophage pro-inflammatory phenotype and cardiac tissue inflammation, partially via pathways that do not require DNA binding.
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Affiliation(s)
- Gregory S Y Ong
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of General Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Timothy J Cole
- Department of Biochemistry, Monash University, Clayton, Victoria, Australia
| | - Gregory H Tesch
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - James Morgan
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennifer K Dowling
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashley Mansell
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter J Fuller
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia
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Hu R, Li X, Peng C, Gao R, Ma L, Hu J, Luo T, Qing H, Wang Y, Ge Q, Wang Z, Wu C, Xiao X, Yang J, Young MJ, Li Q, Yang S. miR-196b-5p-enriched extracellular vesicles from tubular epithelial cells mediated aldosterone-induced renal fibrosis in mice with diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001101. [PMID: 32727744 PMCID: PMC7394302 DOI: 10.1136/bmjdrc-2019-001101] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Aldosterone is a mediator of progressive renal disease, but the mechanisms for aldosterone-mediated renal impairment in mice with diabetes are not fully defined. METHODS Aldosterone and/or mineralocorticoid receptor antagonist eplerenone were used to treat the db/db mice with diabetes. Proximal tubule epithelial cells (PTECs) and fibroblasts were cultured. Blood and kidney samples from patients with diabetes with or without diabetic kidney disease (DKD) were used to verify the findings from animals and cultured cells. RESULTS We found that aldosterone promoted proteinuria and tubulointerstitial extracellular matrix (ECM) accumulation in db/db mice with diabetes while eplerenone mitigated the adverse effect of aldosterone. However, coculture of PTECs and fibroblasts found that when PTECs-derived extracellular vesicles (EVs) were taken up by fibroblasts, ECM production increased remarkably. Moreover, C57BL/6 mice injected with EVs from renal cortex of aldosterone-treated db/db mice showed increased ECM accumulation. Function of the ingredients of PTECs-derived EVs were analyzed, and RNAs were identified to be responsible for the EVs-induced fibroblast dysfunction. Furthermore, microRNA (miRNA) array analysis revealed that miR-196b-5p was the most remarkably increased miRNA in PTECs-derived EVs with aldosterone stimulation. Overexpression of miR-196b-5p in fibroblasts increased ECM production, accompanied by inhibition of the SOCS2 expression and enhanced STAT3 phosphorylation. In addition, plasma levels of miR-196b-5p was higher in patients with DKD as compared with patients without DKD and miR-196b-5p levels positively correlated with the albuminuria concentration. In kidney specimens from patients with diabetes, expression of miR-196b-5p, located mainly in PTECs, increased in patients with DKD as compared with the non-DKD. CONCLUSION This study demonstrates the involvement of miR-196b-5p-EVs pathway as a novel mechanism in aldosterone-induced renal fibrosis in diabetes. EVs rich in miR-196b-5p mediate the crosstalk between PTECs and fibroblast during the development of renal fibrosis, which might be associated with STAT3/SOCO2 signaling pathway.
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Affiliation(s)
- Renzhi Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Peng
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruifei Gao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Linqiang Ma
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Qing
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Ge
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhihong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chaodong Wu
- Nutrition & Food Sciences, Texas A&M University, College Station, Texas, USA
| | - Xiaoqiu Xiao
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Fuller PJ, Yao YZ, Yang J, Young MJ. Structural determinants of activation of the mineralocorticoid receptor: an evolutionary perspective. J Hum Hypertens 2020; 35:110-116. [PMID: 32467588 DOI: 10.1038/s41371-020-0360-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
The mineralocorticoid receptor (MR) plays a central role in sodium homoeostasis by transducing the response to aldosterone in the distal nephron and other sodium transporting epithelia. The MR is a member of the nuclear receptor family of ligand-dependent transcription factors; it is unusual in being the receptor for two steroid hormones aldosterone and cortisol (which also binds to the closely related glucocorticoid receptor). Less well recognised is that progesterone also binds to the MR with high affinity. The conformation of the ligand-bound receptor is determined by the ligand including whether the conformation is agonist or antagonist. An agonist MR conformation then enables interactions with DNA, other MR (homodimerization) and coregulatory molecules to regulate gene expression. Insights into the structural determinants of an agonist response to ligand come from studies of the evolution of the MR. Progesterone is an agonist in the fish MR, but antagonist in the MR of terrestrial vertebrates; this switch results from the loss of a critical leucine that mediates a leucine:leucine interaction between helix 1 and helix 8 which enables the agonist response to progesterone. The insights into the intramolecular dynamics of activation suggest novel ways in which MR antagonism may be achieved beyond the current, progesterone-based antagonists in clinical use.
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Affiliation(s)
- Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia. .,Department of Molecular Translational Science, The Monash University, Clayton, VIC, 3168, Australia.
| | - Yi-Zhou Yao
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Molecular Translational Science, The Monash University, Clayton, VIC, 3168, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Molecular Translational Science, The Monash University, Clayton, VIC, 3168, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Molecular Translational Science, The Monash University, Clayton, VIC, 3168, Australia
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41
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Bui CB, Kolodziej M, Lamanna E, Elgass K, Sehgal A, Rudloff I, Schwenke DO, Tsuchimochi H, Kroon MAGM, Cho SX, Maksimenko A, Cholewa M, Berger PJ, Young MJ, Bourke JE, Pearson JT, Nold MF, Nold-Petry CA. Interleukin-1 Receptor Antagonist Protects Newborn Mice Against Pulmonary Hypertension. Front Immunol 2019; 10:1480. [PMID: 31354700 PMCID: PMC6637286 DOI: 10.3389/fimmu.2019.01480] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/13/2019] [Indexed: 12/18/2022] Open
Abstract
Pulmonary hypertension secondary to bronchopulmonary dysplasia (BPD-PH) represents a major complication of BPD in extremely preterm infants for which there are currently no safe and effective interventions. The abundance of interleukin-1 (IL-1) is strongly correlated with the severity and long-term outcome of BPD infants and we have previously shown that IL-1 receptor antagonist (IL-1Ra) protects against murine BPD; therefore, we hypothesized that IL-1Ra may also be effective against BPD-PH. We employed daily injections of IL-1Ra in a murine model in which BPD/BPD-PH was induced by antenatal LPS and postnatal hyperoxia of 65% O2. Pups reared in hyperoxia for 28 days exhibited a BPD-PH-like disease accompanied by significant changes in pulmonary vascular morphology: micro-CT revealed an 84% reduction in small vessels (4-5 μm diameter) compared to room air controls; this change was prevented by IL-1Ra. Pulmonary vascular resistance, assessed at day 28 of life by echocardiography using the inversely-related surrogate marker time-to-peak-velocity/right ventricular ejection time (TPV/RVET), increased in hyperoxic mice (0.27 compared to 0.32 in air controls), and fell significantly with daily IL-1Ra treatment (0.31). Importantly, in vivo cine-angiography revealed that this protection afforded by IL-1Ra treatment for 28 days is maintained at day 60 of life. Despite an increased abundance of mediators of pulmonary angiogenesis in day 5 lung lysates, namely vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1), no difference was detected in ex vivo pulmonary vascular reactivity between air and hyperoxia mice as measured in precision cut lung slices, or by immunohistochemistry in alpha-smooth muscle actin (α-SMA) and endothelin receptor type-A (ETA) at day 28. Further, on day 28 of life we observed cardiac fibrosis by Sirius Red staining, which was accompanied by an increase in mRNA expression of galectin-3 and CCL2 (chemokine (C-C motif) ligand 2) in whole hearts of hyperoxic pups, which improved with IL-1Ra. In summary, our findings suggest that daily administration of the anti-inflammatory IL-1Ra prevents the increase in pulmonary vascular resistance and the pulmonary dysangiogenesis of murine BPD-PH, thus pointing to IL-1Ra as a promising candidate for the treatment of both BPD and BPD-PH.
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Affiliation(s)
- Christine B Bui
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | | | - Emma Lamanna
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Kirstin Elgass
- Monash Micro Imaging, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Clayton, VIC, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Ina Rudloff
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Daryl O Schwenke
- Department of Physiology-Heart Otago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Hirotsugu Tsuchimochi
- Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Maurice A G M Kroon
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Pharmacy, Amsterdam UMC, Amsterdam, Netherlands
| | - Steven X Cho
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Anton Maksimenko
- Imaging and Medical Beamline, Australian Synchrotron, Clayton, VIC, Australia
| | - Marian Cholewa
- Centre for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow, Rzeszow, Poland
| | - Philip J Berger
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Jane E Bourke
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - James T Pearson
- Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Marcel F Nold
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Claudia A Nold-Petry
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
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Fletcher ELK, Kanki M, Morgan J, Ray DW, Delbridge L, Fuller PJ, Clyne CD, Young MJ. Cardiomyocyte transcription is controlled by combined MR and circadian clock signalling. J Endocrinol 2019; 241:JOE-18-0584.R3. [PMID: 30689544 DOI: 10.1530/joe-18-0584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022]
Abstract
We previously identified a critical pathogenic role for MR activation in cardiomyocytes that included a potential interaction between the MR and the molecular circadian clock. While glucocorticoid regulation of the circadian clock is undisputed, MR interactions with circadian clock signalling are limited. We hypothesised that the MR influences cardiac circadian clock signalling, and vice versa. 10nM aldosterone or corticosterone regulated CRY 1, PER1, PER2 and ReverbA (NR1D1) gene expression patterns in H9c2 cells over 24hr. MR-dependent regulation of circadian gene promoters containing GREs and E-box sequences was established for CLOCK, Bmal, CRY 1 and CRY2, PER1 and PER2 and transcriptional activators CLOCK and Bmal modulated MR-dependent transcription of a subset of these promoters. We also demonstrated differential regulation of MR target gene expression in hearts of mice 4hr after administration of aldosterone at 8AM versus 8PM. Our data support combined MR regulation of a subset of circadian genes and that endogenous circadian transcription factors CLOCK and Bmal modulate this response. This unsuspected relationship links MR in the heart to circadian rhythmicity at the molecular level and has important implications for the biology of MR signalling in response to aldosterone as well as cortisol. These data are consistent with MR signalling in the brain where, like the heart, it preferentially responds to cortisol. Given the undisputed requirement for diurnal cortisol release in the entrainment of peripheral clocks, the present study highlights the MR as an important mechanism for transducing the circadian actions of cortisol in addition to the GR in the heart.
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Affiliation(s)
- ELizabeth K Fletcher
- E Fletcher, Sackler School of Graduate Biomedical Sciences, Tuft Medical Centre, Boston, United States
| | - Monica Kanki
- M Kanki, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Australia
| | - James Morgan
- J Morgan, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Australia
| | - David W Ray
- D Ray, Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Lea Delbridge
- L Delbridge, Dept Of Physiology, University of Melbourne, Melbourne, xxx, Australia
| | - Peter James Fuller
- P Fuller, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Australia
| | - Colin D Clyne
- C Clyne , Cancer Drug Discovery, Hudson Institute of Medical Research, Clayton, Australia
| | - Morag J Young
- M Young, Cardiovascular Endocrinology, Hudson Institute of Medical Research, Clayton, 3166, Australia
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44
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Young MJ, Adler GK. Aldosterone, the Mineralocorticoid Receptor and Mechanisms of Cardiovascular Disease. Vitamins and Hormones 2019; 109:361-385. [DOI: 10.1016/bs.vh.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Introduction Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The number of TURPs performed has declined significantly over the last three decades owing to pharmaceutical therapy. TURP data from a single institution for the years 1990, 2000 and 2010 were compared to assess the difference in performance. Methods A retrospective analysis was undertaken of all patients who underwent TURP between January and December 2010. These findings were compared with historical data for the years 1990 and 2000: 100 sets of case notes were selected randomly from each of these years. Results The number of TURPs performed fell from 326 in 1990 to 113 in 2010. The mean age of patients increased from 70.6 years to 74.0 years. There was also a significant increase in the mean ASA grade from 1.9 to 2.3. The most common indication for TURP shifted from LUTS to acute urinary retention. No significant change in operating time was observed. The mean resection weight remained constant (22.95g in 1990, 22.55g in 2000, 20.76g in 2010). A reduction in transfusion rates was observed but there were higher rates of secondary haematuria and bladder neck stenosis. There was an increase from 2% to 11.5% of patients with long-term failure to void following TURP. Conclusions The number of TURPs performed continues to decline, which could lead to potential training issues. Urinary retention is still by far the most common indication. However, there has been a significant rise in the percentage of men presenting for TURP with high pressure chronic retention. The number of patients with bladder dysfunction who either have persistent storage LUTS or eventually require long-term catheterisation or intermittent self-catheterisation has increased markedly, which raises the question of what the long-term real life impact of medical therapy is on men with LUTS secondary to benign prostatic hyperplasia who eventually require surgery.
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Affiliation(s)
- MJ Young
- York Teaching Hospital NHS Foundation Trust, UK
| | | | - T Morrison
- York Teaching Hospital NHS Foundation Trust, UK
| | - JR Wilson
- York Teaching Hospital NHS Foundation Trust, UK
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Bonham MP, Leung GKW, Davis R, Sletten TL, Murgia C, Young MJ, Eikelis N, Lambert EA, Huggins CE. Does modifying the timing of meal intake improve cardiovascular risk factors? Protocol of an Australian pilot intervention in night shift workers with abdominal obesity. BMJ Open 2018; 8:e020396. [PMID: 29540423 PMCID: PMC5857653 DOI: 10.1136/bmjopen-2017-020396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Shift work is an independent risk factor for cardiovascular disease (CVD). Shift workers who are awake overnight and sleep during the day are misaligned with their body's endogenous circadian rhythm. Eating at night contributes to this increased risk of CVD by forcing the body to actively break down and process nutrients at night. This pilot study aims to determine whether altering meal timing overnight, in a shift working population, will impact favourably on modifiable risk factors for CVD (postprandial bplasma lipids and glucose concentration). METHODS AND ANALYSIS A randomised cross-over study with two 4-week test periods, separated by a minimum of a 2-week washout will be undertaken. The effectiveness of redistributing energy intake overnight versus ad libitum eating patterns on CVD risk factors will be examined in night shift workers (n=20), using a standard acute test meal challenge protocol. Primary outcomes (postprandial lipids and glucose) will be compared between the two conditions: post-intervention and post-control period using analysis of variance. Potential effect size estimates to inform sample size calculations for a main trial will also be generated. ETHICS AND DISSEMINATION Ethics approval has been granted by the Monash University Human Research Ethics Committee (2017-8619-10329). Outcomes from this study will determine whether eliminating food intake for a defined period at night (1-6 am) impacts favourably on metabolic risk factors for CVD in night shift workers. Collective results from this novel trial will be disseminated through peer-reviewed journals, and national and international presentations. The results are essential to inform health promotion policies and guidelines for shift workers, especially those who aim to improve their metabolic health. TRIAL REGISTRATION NUMBER ACTRN12617000791336; Pre-results.
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Affiliation(s)
- Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Gloria K W Leung
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Rochelle Davis
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Tracey L Sletten
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Notting Hill, Victoria, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Notting Hill, Victoria, Australia
| | - Chiara Murgia
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Nina Eikelis
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Elisabeth A Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Department of Physiology, Monash University, Clayton, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
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Bienvenu LA, Morgan J, Reichelt ME, Delbridge LM, Young MJ. Chronic in vivo nitric oxide deficiency impairs cardiac functional recovery after ischemia in female (but not male) mice. J Mol Cell Cardiol 2017; 112:8-15. [DOI: 10.1016/j.yjmcc.2017.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 12/29/2022]
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Uldahl KB, Walk ST, Olshefsky SC, Young MJ, Peng X. SMV1, an extremely stable thermophilic virus platform for nanoparticle trafficking in the mammalian GI tract. J Appl Microbiol 2017; 123:1286-1297. [PMID: 28891224 DOI: 10.1111/jam.13584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/22/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022]
Abstract
AIMS Analysis of the stability and safety of Sulfolobus monocaudavirus 1 (SMV1) during passage through the mammalian GI tract. METHODS AND RESULTS A major challenge of using nano-vectors to target gut microbiome is their survival during passage through the extremely acidic and proteolytic environment of the mammalian GI tract. Here, we investigated the thermo-acidophilic archaeal virus SMV1 as a candidate therapeutic nano-vector for the distal mammalian GI tract microbiome. We investigated the anatomical distribution, vector stability and immunogenicity of this virus following oral ingestion in mice and compared these traits to the more classically used Inovirus vector M13KE. We found that SMV1 particles were highly stable under both simulated GI tract conditions (in vitro) and in mice (in vivo). Moreover, SMV1 could not be detected in tissues outside the GI tract and it elicited a nearly undetectable inflammatory response. Finally, we used human intestinal organoids (HIOs) to show that labelled SMV1 did not invade or otherwise perturb the human GI tract epithelium. CONCLUSION Sulfolobus monocaudavirus 1 appeared stable and safe during passage though the mammalian GI tract. SIGNIFICANCE AND IMPACT OF THE STUDY This is the first study evaluating an archaeal virus as a potential therapeutic nanoparticle delivery system and it opens new possibilities for future development of novel nanoplatforms.
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Affiliation(s)
- K B Uldahl
- Danish Archaea Centre and Department of biology, University of Copenhagen, Copenhagen, Denmark
| | - S T Walk
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
| | - S C Olshefsky
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
| | - M J Young
- Thermal Biology Institute and Department of Plant Sciences and Plant Pathology, Montana State University, Bozeman, MT, USA
| | - X Peng
- Danish Archaea Centre and Department of biology, University of Copenhagen, Copenhagen, Denmark
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Fletcher EK, Morgan J, Kennaway DR, Bienvenu LA, Rickard AJ, Delbridge LMD, Fuller PJ, Clyne CD, Young MJ. Deoxycorticosterone/Salt-Mediated Cardiac Inflammation and Fibrosis Are Dependent on Functional CLOCK Signaling in Male Mice. Endocrinology 2017; 158:2906-2917. [PMID: 28911177 DOI: 10.1210/en.2016-1911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 07/13/2017] [Indexed: 12/19/2022]
Abstract
Activation of the mineralocorticoid receptor (MR) promotes inflammation, fibrosis, and hypertension. Clinical and experimental studies show that MR antagonists have significant therapeutic benefit for all-cause heart failure; however, blockade of renal MRs limits their widespread use. Identification of key downstream signaling mechanisms for the MR in the cardiovascular system may enable development of targeted MR antagonists with selectivity for pathological MR signaling and lower impact on physiological renal electrolyte handling. One candidate pathway is the circadian clock, the dysregulation of which is associated with cardiovascular diseases. We have previously shown that the circadian gene Per2 is dysregulated in hearts with selective deletion of cardiomyocyte MR. We therefore investigated MR-mediated cardiac inflammation and fibrosis in mice that lack normal regulation and oscillation of the circadian clock in peripheral tissues, that is, CLOCKΔ19 mutant mice. The characteristic cardiac inflammatory/fibrotic response to a deoxycorticosterone (DOC)/salt for 8 weeks was significantly blunted in CLOCKΔ19 mice when compared with wild-type mice, despite a modest increase at "baseline" for fibrosis and macrophage number in CLOCKΔ19 mice. In contrast, cardiac hypertrophy in response to DOC/salt was significantly greater in CLOCKΔ19 vs wild-type mice. Markers for renal inflammation and fibrosis were similarly attenuated in the CLOCKΔ19 mice given DOC/salt. Moreover, increased CLOCK expression in H9c2 cardiac cells enhanced MR-mediated transactivation of Per1, suggesting cooperative signaling between these transcription factors. This study demonstrates that the full development of MR-mediated cardiac inflammation and fibrosis is dependent on intact signaling by the circadian protein CLOCK.
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Affiliation(s)
- Elizabeth K Fletcher
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
- Department of Physiology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - James Morgan
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - David R Kennaway
- School of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Laura A Bienvenu
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
- Department of Physiology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Amanda J Rickard
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Lea M D Delbridge
- Department of Physiology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Colin D Clyne
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
- Department of Physiology, Monash University, Clayton, Victoria 3168, Australia
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Cole TJ, Young MJ. 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor null mice: informing cell-type-specific roles. J Endocrinol 2017; 234:T83-T92. [PMID: 28550025 DOI: 10.1530/joe-17-0155] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/12/2022]
Abstract
The mineralocorticoid receptor (MR) mediates the actions of two important adrenal corticosteroid hormones, aldosterone and cortisol. The cell signalling roles of the MR in vivo have expanded enormously since the cloning of human MR gene 30 years ago and the first MR gene knockout in mice nearly 20 years ago. Complete ablation of the MR revealed important roles postnatally for regulation of kidney epithelial functions, with MR-null mice dying 1-2 weeks postnatally from renal salt wasting and hyperkalaemia, with elevated plasma renin and aldosterone. Generation of tissue-selective MR-deficient mice using Cre recombinase-LoxP gene targeting has made it possible to analyse mice lacking MR only in specific cell types. Targeting renal-specific MR has differentiated roles in specific compartments of the kidney. Ablating MR in neurons of the forebrain reinforced important roles of the MR in response to stress, behaviour and anxiety, but suggested a minimal role in maintaining basal HPA axis tone. Deletion of the MR in macrophages and other cell types of the cardiovascular system clearly defined important roles for the regulation of cardiovascular physiology and pathophysiology. Knockdown of MR mRNA in vivo using antisense/siRNA approaches, and similarly MR overexpression, has provided useful rodent models to study physiological roles of MR signalling in vivo More recently, targeted mutation of specific domains of the MR such as the DBD has defined genomic vs non-genomic roles in vivo New tissue-selective MR-null models are required to define roles of MR signalling in other regions of the brain, the eye, gastrointestinal tract, lung, skin, breast and gonadal organs.
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Affiliation(s)
- Timothy J Cole
- Department of Biochemistry and Molecular BiologyMonash University, Melbourne, Victoria, Australia
- Centre for Endocrinology and MetabolismHudson Institute of Medical Research, Monash Medical Centre, Clayton, Victoria, Australia
| | - Morag J Young
- Centre for Endocrinology and MetabolismHudson Institute of Medical Research, Monash Medical Centre, Clayton, Victoria, Australia
- Department of Molecular and Translational ResearchMonash University, Melbourne, Victoria, Australia
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