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Abadir P, Cosarderelioglu C, Damarla M, Malinina A, Dikeman D, Marx R, Nader MM, Abadir M, Walston J, Neptune E. Unlocking the protective potential of the angiotensin type 2 receptor (AT 2R) in acute lung injury and age-related pulmonary dysfunction. Biochem Pharmacol 2024; 220:115978. [PMID: 38081369 PMCID: PMC10880333 DOI: 10.1016/j.bcp.2023.115978] [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: 07/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023]
Abstract
Despite its known importance in the cardiovascular system, the specific role and impact of the angiotensin type 2 receptor (AT2R) in lung physiology and pathophysiology remain largely elusive. In this study, we highlight the distinct and specialized lung-specific roles of AT2R, primarily localized to an alveolar fibroblast subpopulation, in contrast to the angiotensin type 1 receptor (AT1R), which is almost exclusively expressed in lung pericytes. Evidence from our research demonstrates that the disruption of AT2R (AT2R-/y), is associated with a surge in oxidative stress and impaired lung permeability, which were further intensified by Hyperoxic Acute Lung Injury (HALI). With aging, AT2R-/y mice show an increase in oxidative stress, premature enlargement of airspaces, as well as increased mortality when exposed to hyperoxia as compared to age-matched WT mice. Our investigation into Losartan, an AT1R blocker, suggests that its primary HALI lung-protective effects are channeled through AT2R, as its protective benefits are absent in AT2R-/y mice. Importantly, a non-peptide AT2R agonist, Compound 21 (C21), successfully reverses lung oxidative stress and TGFβ activation in wild-type (WT) mice exposed to HALI. These findings suggest a possible paradigm shift in the therapeutic approach for lung injury and age-associated pulmonary dysfunction, from targeting AT1R with angiotensin receptor blockers (ARBs) towards boosting the protective function of AT2R.
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Affiliation(s)
- Peter Abadir
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, Department of Medicine, USA.
| | - Caglar Cosarderelioglu
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, Department of Medicine, USA
| | - Mahendra Damarla
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, USA
| | - Alla Malinina
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, USA
| | - Dustin Dikeman
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, USA
| | - Ruth Marx
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, Department of Medicine, USA
| | - Monica M Nader
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, Department of Medicine, USA; Urbana High School, USA
| | | | - Jeremy Walston
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, Department of Medicine, USA
| | - Enid Neptune
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, USA.
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Pastacı Özsobacı N, Karataş M, Tunçdemir M, Özcelik D. Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker on oxidative stress and metabolism of elements in kidney of STZ-induced diabetic rats. Arch Biochem Biophys 2024; 751:109851. [PMID: 38065251 DOI: 10.1016/j.abb.2023.109851] [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: 08/28/2023] [Revised: 10/08/2023] [Accepted: 12/03/2023] [Indexed: 12/22/2023]
Abstract
In diabetes, increased oxidative stress and impaired trace element metabolism play an important role in the pathogenesis of diabetic nephropathy. The objective of this research was to examine the outcomes of blocking the renin-angiotensin system, using either the angiotensin-converting enzyme inhibitor (ACEI), perindopril, or the angiotensin II type 1 (AT1) receptor blocker, irbesartan, on oxidative stress and trace element levels such as Zn, Mg, Cu, and Fe in the kidneys of diabetic rats that had been induced with streptozotocin. Thirty-two Wistar albino male rats were equally divided into four groups. The first group was used as a control. The second group of rats developed diabetes after receiving a single intraperitoneal dose of STZ. The third and fourth groups of rats had STZ-induced diabetes and received daily dosages of irbesartan (15 mg/kg b.w/day) and perindopril (6 mg/kg b.w/day) treatment, respectively. Biochemical analysis of the kidneys showed a distinct increase in oxidative stress, indicated by heightened levels of malondialdehyde (MDA) and decreased superoxide dismutase (SOD) activities, as well as reduced glutathione (GSH) levels in the kidneys of diabetic rats. In the kidneys of diabetic rats, the mean levels of Fe and Cu were found to be significantly higher than those of the control group. Additionally, the mean levels of Zn and Mg were significantly lower in the diabetic rats compared to the control rats. Both perindopril and irbesartan decreased significantly MDA content and increased SOD activities and GSH levels in the kidneys of rats with diabetes. The Zn and Mg concentrations in the kidneys of diabetic rats treated with perindopril and irbesartan were markedly higher than in untreated STZ-diabetic rats, while the Cu and Fe concentrations were significantly lower. The urinary excretion of rats treated with perindopril and irbesartan showed a pronounced increase in Cu levels, along with a significant reduction in Zn and Mg levels. Although diabetic rats demonstrated degenerative morphological alterations in their kidneys, both therapies also improved diabetes-induced histopathological modifications in the kidneys. Finally, the present results suggest that manipulating the levels of Zn, Mg, Cu, and Fe - either through ACE inhibition or by blocking AT1 receptors - could be advantageous in reducing lipid peroxidation and increasing antioxidant concentration in the kidneys of diabetic rats.
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Affiliation(s)
- Nural Pastacı Özsobacı
- Department of Biophysics, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Fatih, Istanbul, Turkiye.
| | - Metehan Karataş
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Fatih, Istanbul, Turkiye
| | - Matem Tunçdemir
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Fatih, Istanbul, Turkiye
| | - Derviş Özcelik
- Department of Biophysics, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Fatih, Istanbul, Turkiye; Department of Biophysics, Medical Faculty, Istanbul Arel University, Istanbul, Turkiye
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Gadanec LK, Swiderski J, Apostolopoulos V, Kelaidonis K, Vidali VP, Canko A, Moore GJ, Matsoukas JM, Zulli A. Existence of Quantum Pharmacology in Sartans: Evidence in Isolated Rabbit Iliac Arteries. Int J Mol Sci 2023; 24:17559. [PMID: 38139391 PMCID: PMC10744031 DOI: 10.3390/ijms242417559] [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: 10/22/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Quantum pharmacology introduces theoretical models to describe the possibility of ultra-high dilutions to produce biological effects, which may help to explain the placebo effect observed in hypertensive clinical trials. To determine this within physiology and to evaluate novel ARBs, we tested the ability of known angiotensin II receptor blockers (ARBs) (candesartan and telmisartan) used to treat hypertension and other cardiovascular diseases, as well as novel ARBs (benzimidazole-N-biphenyl tetrazole (ACC519T), benzimidazole-bis-N,N'-biphenyl tetrazole (ACC519T(2)) and 4-butyl-N,N0-bis[[20-2Htetrazol-5-yl)biphenyl-4-yl]methyl)imidazolium bromide (BV6(K+)2), and nirmatrelvir (the active ingredient in Paxlovid) to modulate vascular contraction in iliac rings from healthy male New Zealand White rabbits in responses to various vasopressors (angiotensin A, angiotensin II and phenylephrine). Additionally, the hemodynamic effect of ACC519T and telmisartan on mean arterial pressure in conscious rabbits was determined, while the ex vivo ability of BV6(K+)2 to activate angiotensin-converting enzyme-2 (ACE2) was also investigated. We show that commercially available and novel ARBs can modulate contraction responses at ultra-high dilutions to different vasopressors. ACC519T produced a dose-dependent reduction in rabbit mean arterial pressure while BV6(K+)2 significantly increased ACE2 metabolism. The ability of ARBs to inhibit contraction responses even at ultra-low concentrations provides evidence of the existence of quantum pharmacology. Furthermore, the ability of ACC519T and BV6(K+)2 to modulate blood pressure and ACE2 activity, respectively, indicates their therapeutic potential against hypertension.
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Affiliation(s)
- Laura Kate Gadanec
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia; (L.K.G.); (J.S.); (V.A.)
| | - Jordan Swiderski
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia; (L.K.G.); (J.S.); (V.A.)
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia; (L.K.G.); (J.S.); (V.A.)
- Immunology Program, Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, VIC 3021, Australia
| | | | - Veroniki P. Vidali
- Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research “Demokritos”, Ag. Paraskevi, 153 41 Athens, Greece; (V.P.V.); (A.C.)
| | - Aleksander Canko
- Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research “Demokritos”, Ag. Paraskevi, 153 41 Athens, Greece; (V.P.V.); (A.C.)
| | - Graham J. Moore
- Pepmetics Inc., 772 Murphy Place, Victoria, BC V6Y 3H4, Canada;
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - John M. Matsoukas
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia; (L.K.G.); (J.S.); (V.A.)
- NewDrug PC, Patras Science Park, 26 504 Patras, Greece;
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Chemistry, University of Patras, 265 04 Patras, Greece
| | - Anthony Zulli
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia; (L.K.G.); (J.S.); (V.A.)
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Severinsen T, Thune JJ, Gudmundsdottir HL, Vissing CR, Iversen K, Ho CY, Bundgaard H, Axelsson Raja A. Angiotensin receptor blockers in patients with hypertrophic cardiomyopathy: A comparison of VANISH and INHERIT randomized trials. Am Heart J 2023; 266:198-200. [PMID: 37980092 DOI: 10.1016/j.ahj.2023.08.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/10/2023] [Accepted: 08/19/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To identify the cause of discrepancy between the INHERIT trial and VANISH trial in regards to disease modification of angiotensin receptor II blockers in hypertrophic cardiomyopathy (HCM). METHODS We replicated the data analysis used in VANISH, converting individual change in each component of the composite endpoint into a z-score and applying this z-score to the INHERIT results. RESULTS No significant improvement was identified in the composite z-score between the 2 groups at 12-month follow-up (P = .4). With the exception of tissue Doppler systolic (s') velocity, we found no significant benefit or harm from losartan compared to placebo for any of the individual components of the composite score at 12-month follow-up. Results were similar in analyses without imputed data or when restricted to patients with sarcomeric HCM. CONCLUSION Despite applying the potentially more sensitive composite z-score endpoint as in the VANISH trial, no statistically significant benefits from the use of losartan compared to placebo could be detected at 12-month follow-up in patients with overt HCM participating in the INHERIT trial.
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Affiliation(s)
- Tino Severinsen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helga Lillian Gudmundsdottir
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Rasmus Vissing
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev-Gentofte, Copenhagen, Denmark
| | - Carolyn Yung Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Zakiev VD, Kotovskaya YV, Tkacheva ON. [Sartans in the treatment of arterial hypertension: focus on telmisartan and azilsartan. A review]. TERAPEVT ARKH 2023; 95:810-817. [PMID: 38158926 DOI: 10.26442/00403660.2023.09.202423] [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: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 01/03/2024]
Abstract
The activity of the renin-angiotensin-aldosterone system is one of the main pathogenetic mechanisms underlying cardiovascular diseases at all stages of the cardiovascular continuum. This article discusses the role of telmisartan and azilsartan as the most powerful sartans in modern cardiology. Azilsartan and especially telmisartan have a significant organoprotection and are superior to other antihypertensive drugs in terms of lowering blood pressure. However, the effect of azilsartan on hard endpoints has not been studied while the efficacy of telmisartan on hard endpoints has been evaluated in plenty clinical trials including 3 large randomized clinical trials with several thousand patients. The article also presents calculations showing the better cost-effectiveness of telmisartan compared to azilsartan.
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Affiliation(s)
- V D Zakiev
- Pirogov Russian National Research Medical University
| | | | - O N Tkacheva
- Pirogov Russian National Research Medical University
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Olfe J, Kanitz JJ, Stark VC, Stute F, von Kodolitsch Y, Biermann D, Huebler M, Kozlik-Feldmann R, Mir TS. Prophylactic effect of angiotensin receptor blockers in children with genetic aortopathies: the early bird catches the worm. Clin Res Cardiol 2023; 112:1610-1619. [PMID: 37160466 PMCID: PMC10584712 DOI: 10.1007/s00392-023-02221-4] [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] [Received: 01/26/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
AIMS In genetic aortopathies (GA) particular attention is paid to aortic root dilatation which has an impact on morbidity and mortality. This study focuses on the effects of therapy with angiotensin-II-receptor-blockers (ARB) or beta-blockers (BB) on aortic root growth and the question which therapy should be initiated at which dosage and at what age. METHODS Since 1998 we diagnosed 208 patients with GA (170 FBN-1). 81 patients between 5 months and 18 years receiving either ARB or BB therapy were included. We retrospectively analyzed the progression of the dilatation of Sinus Valsalva aortae (SV) using calculated z-scores before and after therapy initiation and compared BB and ARB treatment. RESULTS Both ARB and BB (p < 0.05) therapy showed significant improvement in aortic root growth, while the effect is significantly more pronounced in ARB (p < 0.01) independent of age and genetic cause. A detailed comparison of the two drug groups showed a more sustained effect in limiting the progression of the dilatation of the aortic root in patients treated with ARB. Progression of dilatation of the SV was significantly lower in children treated with ARBs compared to BB (delta z-score, p < 0.05). In addition, ARBs were better tolerated and had a significantly lower discontinuation rate (3%) compared to BB (50%) (p < 0.01). Independently of age at initiation all children and adolescents were able to reach the target dose under ARB. CONCLUSION We demonstrated a significant change in both treatment options, with the effect of ARB being more pronounced while being better tolerated throughout the treatment period.
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Affiliation(s)
- J Olfe
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site/Kiel/Lübeck, Hamburg, Germany
| | - J J Kanitz
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - V C Stark
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - F Stute
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Y von Kodolitsch
- German Aortic Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site/Kiel/Lübeck, Hamburg, Germany
| | - D Biermann
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site/Kiel/Lübeck, Hamburg, Germany
| | - M Huebler
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - R Kozlik-Feldmann
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site/Kiel/Lübeck, Hamburg, Germany
| | - T S Mir
- Children´s Heart Clinic, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site/Kiel/Lübeck, Hamburg, Germany.
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Haji Ali B, Shirvaliloo M, Fathi-Karkan S, Mirinejad S, Ulucan-Karnak F, Sargazi S, Sargazi S, Sheervalilou R, Rahman MM. Nanotechnology-Based Strategies for Extended-Release Delivery of Angiotensin Receptor Blockers (ARBs): A Comprehensive Review. Chem Biodivers 2023; 20:e202301157. [PMID: 37796134 DOI: 10.1002/cbdv.202301157] [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: 08/26/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/06/2023]
Abstract
There has been a significant shift in the perception of hypertension as an important contributor to the global disease burden. Approximately 6 % and 8 % of pregnancies are affected by hypertension, which can adversely affect the mother and the fetus. Furthermore, a hypertensive individual is at increased risk of developing kidney disease, arterial hardening, eye damage, and strokes. Using angiotensin receptor blockers (ARBs) is widespread in treating hypertension, heart failure, coronary artery disease, and diabetic nephropathy. Despite this, some ARBs have limited use due to their poor oral bioavailability and water solubility. To tackle this, a variety of nanoparticle (NP)-based systems, such as polymeric NPs (i. e., dendrimers), polymeric micelles, polymer-drug conjugates, lipid NPs, nanoemulsions, self-emulsifying drug delivery systems (SEDDS), solid lipid NPs (SLNs), nanostructured lipid carriers (NLCs), carbon-based nanocarriers, inorganic NPs, and nanocrystals, have been recently developed for efficient delivery of losartan, Valsartan (Val), Olmesartan (OLM), Telmisartan (TEL), Candesartan, Eprosartan, Irbesartan, and Azilsartan to target cells. This review article provides a literature-based comparison of the various classes of ARBs, their mechanisms of action, and an overview of the nanoformulations developed for ARB delivery and successfully applied to managing hypertension, diabetic complications, and other conditions.
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Affiliation(s)
- Bahareh Haji Ali
- Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Shirvaliloo
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sonia Fathi-Karkan
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, 9453155166, Iran
- Department of Advanced Sciences and Technologies in Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, 9414974877, Iran
| | - Shekoufeh Mirinejad
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fulden Ulucan-Karnak
- Department of Medical Biochemistry, Institute of Health Sciences, Ege University, İzmir, 35100, Turkey
| | - Saman Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran, Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sara Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Roghayeh Sheervalilou
- Pharmacology Research Center, Zahedan University of Medical Sciences, Zahedan, 9816743463, Iran
| | - Mohammed M Rahman
- Center of Excellence for Advanced Materials Research (CEAMR) & Department of Chemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
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Son SE, Im DS. Therapeutic effects of candesartan in inflammatory skin disorders by suppressing Th17 differentiation. Int Immunopharmacol 2023; 124:110995. [PMID: 37801970 DOI: 10.1016/j.intimp.2023.110995] [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: 04/10/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
As angiotensin II is associated with inflammation, type I angiotensin II receptor blockers (ARBs) exibit anti-inflammatory effects in patients with hypertension as well as inflammatory disease animal models including arthritis models. The present study aimed to investigate whether ARBs exert anti-inflammatory effects in vivo in skin disorders. We tested effects of ARBs on 1-chloro-2,4-dinitrobenzene(CDNB)-induced atopic dermatitis-like and imiquimod-induced psoriasis-like skin models. CDNB-induced atopic dermatitis-like skin lesions were suppressed by administration of candesartan or telmisartan. The suppressive effect of telmisartan was blocked by the presence of GW9662, a selective PPARγ inhibitor, but not that of candesartan. Both ARBs suppressed increases in pro-inflammatory cytokine (IL-4, IL-13, IFN-γ, and IL-17A) levels, and GW9662 inhibited telmisartan-induced suppression but not candesartan. Candesartan significantly inhibited in vitro differentiation of naïve T cells into Th17 cells to a greater extent than telmisartan. In the imiquimod-induced psoriasis model, whose primary etiology is activation of IL-23/IL-17 axis, candesartan significantly suppressed psoriasis-like skin lesions and Th17 cell populations in both lymph nodes and spleens to a greater extent than telmisartan. Overall, certain ARBs may have anti-inflammatory effects in skin diseases. Candesartan may have therapeutic implications in inflammatory skin disorders by suppressing Th17 differentiation, while telmisartan might have therapeutic potential by activating PPARγ.
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Affiliation(s)
- So-Eun Son
- Department of Biomedical and Pharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Dong-Soon Im
- Department of Biomedical and Pharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Fundamental Pharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea.
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Choi JS, Kim JY, Ahn MJ, Jang H, Song S, Choi SH, Park YS, Jo S, Kim TH, Shim SC. Angiotensin receptor blockers, but not angiotensin-converting enzyme inhibitors, inhibit abnormal bone changes in spondyloarthritis. Exp Mol Med 2023; 55:2346-2356. [PMID: 37907743 PMCID: PMC10689434 DOI: 10.1038/s12276-023-01103-z] [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: 03/01/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 11/02/2023] Open
Abstract
Spondyloarthritis (SpA) is a chronic inflammatory disease that results in bone ankylosis. The tissue renin-angiotensin system (RAS) is an emerging pathway potentially implicated in SpA-associated bone changes. The aim of the present study was to determine the mechanisms underlying this relationship. Sakaguchi (SKG) mice injected with curdlan (SKGc), animal models for SpA, were treated with RAS modulators, angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEis). Disease activity was assessed using clinical scores and computed tomography scans. Mouse primary bone marrow monocytes (BMMs), osteoblast (OB) progenitor cells, peripheral blood monocytes (PBMCs), and bone-derived cells (BdCs) from patients with radiographic axial SpA (r-axSpA) were used to investigate the role of RAS in SpA pathogenesis. The expression of RAS components was significantly increased in SKGc mouse joints, and ARBs significantly reduced erosion and systemic bone loss, whereas ACEis did not. Osteoclast (OC) differentiation from primary BMMs, mediated by TRAF6, was inhibited by ARBs but promoted by ACEis; the modulators also exerted opposite effects on OB differentiation. Expression of RAS molecules was higher in PBMCs and BdCs of patients with r-axSpA than in control participants. ARBs inhibited OB differentiation in the BdCs of patients with r-axSpA, whereas ACEis did not. Neither ARBs nor ACEis affected OB differentiation in the control participants. In SpA, a condition characterized by RAS overexpression, ARBs, but not ACEis, inhibited OC and OB differentiation and bone progression. The findings should be taken into account when treating patients with SpA using RAS modulators.
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Affiliation(s)
- Jin Sun Choi
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Ji-Young Kim
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Min-Joo Ahn
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Hanbit Jang
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Seungtaek Song
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, 04763, Republic of Korea
| | - Ye-Soo Park
- Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, 11923, Republic of Korea
| | - Sungsin Jo
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, 04763, Republic of Korea
| | - Tae-Hwan Kim
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, 04763, Republic of Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, Republic of Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea.
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Martínez-Díaz I, Martos N, Llorens-Cebrià C, Álvarez FJ, Bedard PW, Vergara A, Jacobs-Cachá C, Soler MJ. Endothelin Receptor Antagonists in Kidney Disease. Int J Mol Sci 2023; 24:ijms24043427. [PMID: 36834836 PMCID: PMC9965540 DOI: 10.3390/ijms24043427] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
Endothelin (ET) is found to be increased in kidney disease secondary to hyperglycaemia, hypertension, acidosis, and the presence of insulin or proinflammatory cytokines. In this context, ET, via the endothelin receptor type A (ETA) activation, causes sustained vasoconstriction of the afferent arterioles that produces deleterious effects such as hyperfiltration, podocyte damage, proteinuria and, eventually, GFR decline. Therefore, endothelin receptor antagonists (ERAs) have been proposed as a therapeutic strategy to reduce proteinuria and slow the progression of kidney disease. Preclinical and clinical evidence has revealed that the administration of ERAs reduces kidney fibrosis, inflammation and proteinuria. Currently, the efficacy of many ERAs to treat kidney disease is being tested in randomized controlled trials; however, some of these, such as avosentan and atrasentan, were not commercialized due to the adverse events related to their use. Therefore, to take advantage of the protective properties of the ERAs, the use of ETA receptor-specific antagonists and/or combining them with sodium-glucose cotransporter 2 inhibitors (SGLT2i) has been proposed to prevent oedemas, the main ERAs-related deleterious effect. The use of a dual angiotensin-II type 1/endothelin receptor blocker (sparsentan) is also being evaluated to treat kidney disease. Here, we reviewed the main ERAs developed and the preclinical and clinical evidence of their kidney-protective effects. Additionally, we provided an overview of new strategies that have been proposed to integrate ERAs in kidney disease treatment.
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Affiliation(s)
- Irene Martínez-Díaz
- Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Nerea Martos
- Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Carmen Llorens-Cebrià
- Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | | | | | - Ander Vergara
- Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Correspondence: (A.V.); (C.J.-C.)
| | - Conxita Jacobs-Cachá
- Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Correspondence: (A.V.); (C.J.-C.)
| | - Maria José Soler
- Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
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11
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Rocha HNM, Teixeira GF, Batista GMS, Storch AS, Garcia VP, Mentzinger J, Gomes EAC, Campos MO, Nóbrega ACL, Rocha NG. AT1R blocker prevents mental stress induced retrograde blood flow in overweight/obese men. Physiol Rep 2023; 11:e15566. [PMID: 36636769 PMCID: PMC9837474 DOI: 10.14814/phy2.15566] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023] Open
Abstract
The main goal was to determine the impact of mental stress (MS) on blood flow regulation in overweight/obese men. Fourteen overweight/obese men (27 ± 7 years; 29.8 ± 2.6 kg/m2 ) participated in two randomized experimental sessions with oral administration of the AT1R blocker Olmesartan (40 mg; AT1RB) or placebo (PL). After 2 h, a 5-min acute MS session (Stroop Color Word Test) was administered. Blood flow was assessed at baseline and during the first 3 min of MS by vascular ultrasound in the brachial artery. Blood was collected before (baseline) and during mental stress (MS) for measurement of nitrite (chemiluminescence) and endothelin-1 (ELISA kit). The AT1R blocker was able to reverse the MS responses observed in the placebo session for retrograde flow (p < 0.01), retrograde SR (p < 0.01) and oscillatory shear index (p = 0.01). Regarding vasoactive substances, no differences were observed in ET-1 (p > 0.05) responses to MS between experimental sessions. However, for nitrite responses, the administration of the AT1R blocker was able to increase circulating levels of NO (p = 0.03) Blockade of AT1R appears to prevent the decrease in endothelial function by reducing low shear stress and maintaining the vasoactive substances balance after MS in overweight/obese men.
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Affiliation(s)
- Helena N. M. Rocha
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Gabriel F. Teixeira
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
| | - Gabriel M. S. Batista
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Amanda S. Storch
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Vinicius P. Garcia
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Juliana Mentzinger
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
| | - Erika A. C. Gomes
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Monique O. Campos
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Antonio C. L. Nóbrega
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
| | - Natália G. Rocha
- Department of Physiology and Pharmacology, Laboratory of Exercise SciencesFluminense Federal UniversityNiteroiBrazil
- Department of Physiology and Pharmacology, Laboratory of Integrative CardiometabologyFluminense Federal UniversityNiteroiBrazil
- National Institute of Science and Technology (INCT) ‐ Physical (In)activity and Exercise, National Council for Scientific and Technological Development (CNPq), Fluminense Federal UniversityNiteroiBrazil
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12
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McDermott MM, Bazzano L, Peterson CA, Sufit R, Ferrucci L, Domanchuk K, Zhao L, Polonsky TS, Zhang D, Lloyd-Jones D, Leeuwenburgh C, Guralnik JM, Kibbe MR, Kosmac K, Criqui MH, Tian L. Effect of Telmisartan on Walking Performance in Patients With Lower Extremity Peripheral Artery Disease: The TELEX Randomized Clinical Trial. JAMA 2022; 328:1315-1325. [PMID: 36194220 PMCID: PMC9533188 DOI: 10.1001/jama.2022.16797] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
Importance Patients with lower extremity peripheral artery disease (PAD) have reduced lower extremity perfusion, impaired lower extremity skeletal muscle function, and poor walking performance. Telmisartan (an angiotensin receptor blocker) has properties that reverse these abnormalities. Objective To determine whether telmisartan improves 6-minute walk distance, compared with placebo, in patients with lower extremity PAD at 6-month follow-up. Design, Setting, and Participants Double-blind, randomized clinical trial conducted at 2 US sites and involving 114 participants. Enrollment occurred between December 28, 2015, and November 9, 2021. Final follow-up occurred on May 6, 2022. Interventions The trial randomized patients using a 2 × 2 factorial design to compare the effects of telmisartan plus supervised exercise vs telmisartan alone and supervised exercise alone and to compare telmisartan alone vs placebo. Participants with PAD were randomized to 1 of 4 groups: telmisartan plus exercise (n = 30), telmisartan plus attention control (n = 29), placebo plus exercise (n = 28), or placebo plus attention control (n = 27) for 6 months. The originally planned sample size was 240 participants. Due to slower than anticipated enrollment, the primary comparison was changed to the 2 combined telmisartan groups vs the 2 combined placebo groups and the target sample size was changed to 112 participants. Main Outcomes and Measures The primary outcome was the 6-month change in 6-minute walk distance (minimum clinically important difference, 8-20 m). The secondary outcomes were maximal treadmill walking distance; Walking Impairment Questionnaire scores for distance, speed, and stair climbing; and the 36-Item Short-Form Health Survey physical functioning score. The results were adjusted for study site, baseline 6-minute walk distance, randomization to exercise vs attention control, sex, and history of heart failure at baseline. Results Of the 114 randomized patients (mean age, 67.3 [SD, 9.9] years; 46 were women [40.4%]; and 81 were Black individuals [71.1%]), 105 (92%) completed 6-month follow-up. At 6-month follow-up, telmisartan did not significantly improve 6-minute walk distance (from a mean of 341.6 m to 343.0 m; within-group change: 1.32 m) compared with placebo (from a mean of 352.3 m to 364.8 m; within-group change: 12.5 m) and the adjusted between-group difference was -16.8 m (95% CI, -35.9 m to 2.2 m; P = .08). Compared with placebo, telmisartan did not significantly improve any of the 5 secondary outcomes. The most common serious adverse event was hospitalization for PAD (ie, lower extremity revascularization, amputation, or gangrene). Three participants (5.1%) in the telmisartan group and 2 participants (3.6%) in the placebo group were hospitalized for PAD. Conclusions and Relevance Among patients with PAD, telmisartan did not improve 6-minute walk distance at 6-month follow-up compared with placebo. These results do not support telmisartan for improving walking performance in patients with PAD. Trial Registration ClinicalTrials.gov Identifier: NCT02593110.
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Affiliation(s)
- Mary M. McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, Maryland
| | - Kathryn Domanchuk
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamar S. Polonsky
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Jack M. Guralnik
- Department of Epidemiology, University of Maryland, College Park
| | | | | | | | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
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13
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Chen XS, Wang SH, Liu CY, Gao YL, Meng XL, Wei W, Shou ST, Liu YC, Chai YF. Losartan attenuates sepsis-induced cardiomyopathy by regulating macrophage polarization via TLR4-mediated NF-κB and MAPK signaling. Pharmacol Res 2022; 185:106473. [PMID: 36182039 DOI: 10.1016/j.phrs.2022.106473] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 07/13/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022]
Abstract
Sepsis-induced cardiomyopathy (SIC) is a serious complication of sepsis with high mortality but no effective treatment. The renin angiotensin (Ang) aldosterone system (RAAS) is activated in patients with sepsis but it is unclear how the Ang II/Ang II type 1 receptor (AT1R) axis contributes to SIC. This study examined the link between the Ang II/AT1R axis and SIC as well as the protective effect of AT1R blockers (ARBs). The Ang II level in peripheral plasma and AT1R expression on monocytes were significantly higher in patients with SIC compared with those in non-SIC patients and healthy controls and were correlated with the degree of myocardial injury. The ARB losartan reduced the infiltration of neutrophils, monocytes, and macrophages into the heart and spleen of SIC mice. Additionally, losartan regulated macrophage polarization from the M1 to the M2 subtype via nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, thereby maintaining the mitochondrial dynamics balance in cardiomyocytes and reducing oxidative stress and cardiomyocyte apoptosis. In conclusion, the plasma Ang II level and AT1R expression on plasma monocytes are an important biomarker in SIC. Therapeutic targeting of AT1R, for example with losartan, can potentially protect against myocardial injury in SIC.
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Affiliation(s)
- Xin-Sen Chen
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Shu-Hang Wang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Chen-Yan Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Yu-Lei Gao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Xiang-Long Meng
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Wei Wei
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Song-Tao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China
| | - Yan-Cun Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China.
| | - Yan-Fen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, China.
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14
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Jiao S, Dong Y, Chang X, Wu Y, Li H. Effects of α lipoic acid combined with olmesartan medoxomil on blood glucose and oxidation indicators in patients with diabetic nephropathy: A protocol for a parallel, randomized, double-blind, controlled clinical trial. Medicine (Baltimore) 2022; 101:e29080. [PMID: 35512068 PMCID: PMC9276178 DOI: 10.1097/md.0000000000029080] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is a common microvascular complication of diabetes, which poses a serious threat to the health and life of patients. There is evidence that both α lipoic acid and olmesartan medoxomil have positive effects in the treatment of DN, but whether the 2 have synergistic effects and the effects on blood glucose and oxidation indicators are controversial. METHODS This is a prospective parallel, randomized, double-blind, placebo-controlled trial to study the effects of α lipoic acid in combination with olmesartan medoxomil on blood glucose and oxidation indicators in patients with DN. Participants will be randomly assigned to a treatment group, which will receive α lipoic acid dispersive tablets combined with olmesartan medoxomil tablets, or a control group, which will receive olmesartan medoxomil tablets combined with placebo for 4 weeks, followed up for 12 weeks. Observation indicators include: glycemic indicators [fasting blood glucose, 2 hours postprandial blood glucose and glycosylated hemoglobin], the oxidation indicators [serum glutathione, superoxide dismutase, malondialdehyde, 8-hydroxydeox-yguanosine], and adverse reactions. Finally, SPASS 22.0 software will be used for statistical analysis of the data. DISCUSSION This study will evaluate the effects of α lipoic acid combined with olmesartan medoxomil on blood glucose and oxidation indicators in patients with DN. The results of this study will provide a reference for the clinical use of α lipoic acid combined with olmesartan medoxomil in the treatment of DN. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/VJWXS.
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Affiliation(s)
- Shengfu Jiao
- Wuwei Hospital of Traditional Chinese Medicine, Wuwei, Gansu Province, China
| | - Yuxia Dong
- Wuwei People's Hospital, Wuwei, Gansu Province, China
| | - Xiang Chang
- Wuwei People's Hospital, Wuwei, Gansu Province, China
| | - Yanan Wu
- Wuwei People's Hospital, Wuwei, Gansu Province, China
| | - Haifeng Li
- Wuwei People's Hospital, Wuwei, Gansu Province, China
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15
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Puskarich MA, Ingraham NE, Merck LH, Driver BE, Wacker DA, Black LP, Jones AE, Fletcher CV, South AM, Murray TA, Lewandowski C, Farhat J, Benoit JL, Biros MH, Cherabuddi K, Chipman JG, Schacker TW, Guirgis FW, Voelker HT, Koopmeiners JS, Tignanelli CJ. Efficacy of Losartan in Hospitalized Patients With COVID-19-Induced Lung Injury: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e222735. [PMID: 35294537 PMCID: PMC8928006 DOI: 10.1001/jamanetworkopen.2022.2735] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/23/2022] [Indexed: 12/14/2022] Open
Abstract
Importance SARS-CoV-2 viral entry may disrupt angiotensin II (AII) homeostasis, contributing to COVID-19 induced lung injury. AII type 1 receptor blockade mitigates lung injury in preclinical models, although data in humans with COVID-19 remain mixed. Objective To test the efficacy of losartan to reduce lung injury in hospitalized patients with COVID-19. Design, Setting, and Participants This blinded, placebo-controlled randomized clinical trial was conducted in 13 hospitals in the United States from April 2020 to February 2021. Hospitalized patients with COVID-19 and a respiratory sequential organ failure assessment score of at least 1 and not already using a renin-angiotensin-aldosterone system (RAAS) inhibitor were eligible for participation. Data were analyzed from April 19 to August 24, 2021. Interventions Losartan 50 mg orally twice daily vs equivalent placebo for 10 days or until hospital discharge. Main Outcomes and Measures The primary outcome was the imputed arterial partial pressure of oxygen to fraction of inspired oxygen (Pao2:Fio2) ratio at 7 days. Secondary outcomes included ordinal COVID-19 severity; days without supplemental o2, ventilation, or vasopressors; and mortality. Losartan pharmacokinetics and RAAS components (AII, angiotensin-[1-7] and angiotensin-converting enzymes 1 and 2)] were measured in a subgroup of participants. Results A total of 205 participants (mean [SD] age, 55.2 [15.7] years; 123 [60.0%] men) were randomized, with 101 participants assigned to losartan and 104 participants assigned to placebo. Compared with placebo, losartan did not significantly affect Pao2:Fio2 ratio at 7 days (difference, -24.8 [95%, -55.6 to 6.1]; P = .12). Compared with placebo, losartan did not improve any secondary clinical outcomes and led to fewer vasopressor-free days than placebo (median [IQR], 9.4 [9.1-9.8] vasopressor-free days vs 8.7 [8.2-9.3] vasopressor-free days). Conclusions and Relevance This randomized clinical trial found that initiation of orally administered losartan to hospitalized patients with COVID-19 and acute lung injury did not improve Pao2:Fio2 ratio at 7 days. These data may have implications for ongoing clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT04312009.
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Affiliation(s)
- Michael A. Puskarich
- Department of Emergency Medicine, University of Minnesota, Minneapolis
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Nicholas E. Ingraham
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis
| | - Lisa H. Merck
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
| | - Brian E. Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - David A. Wacker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis
| | - Lauren Page Black
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville
| | - Alan E. Jones
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson
| | | | - Andrew M. South
- Section of Nephrology, Department of Pediatrics, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, North Carolina
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
- Department of Surgery-Hypertension and Vascular Research, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Thomas A. Murray
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Christopher Lewandowski
- Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan
| | - Joseph Farhat
- Department of Surgery, North Memorial Medical Center, Minneapolis, Minnesota
| | - Justin L. Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michelle H. Biros
- Department of Emergency Medicine, University of Minnesota, Minneapolis
| | - Kartik Cherabuddi
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
| | | | - Timothy W. Schacker
- Division of Infectious Disease, Department of Medicine, University of Minnesota, Minneapolis
| | - Faheem W. Guirgis
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville
| | - Helen T. Voelker
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Joseph S. Koopmeiners
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
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16
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Xurui Huang N, Sanderson JE, Fang F, Yu CM, Yan BP. Passive Prescription of Secondary Prevention Medical Therapy during Index Hospitalization for Acute Myocardial Infarction Is Prevalent and Associated with Adverse Clinical Outcomes. J Healthc Eng 2021; 2021:9543912. [PMID: 34976331 PMCID: PMC8718309 DOI: 10.1155/2021/9543912] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Secondary prevention therapy reduces death and reinfarction after acute myocardial infarction (AMI), but it is underutilized in clinical practice. Mechanisms for this therapeutic gap are not well established. In this study, we have explored and evaluated the impact of passive continuation compared to active initiation of secondary prevention therapy for AMI during the index hospitalization. For this purpose, we have analyzed 1083 consecutive patients with AMI to a tertiary referral hospital in Hong Kong and assessed discharge prescription rates of secondary prevention therapies (aspirin, beta-blockers, statins, and ACEI/ARBs). Multivariate analysis was used to identify independent predictors of discharge medication, and Kaplan-Meier survival curve was used to evaluate 12-month survival. Overall, prescription rates of aspirin, beta-blocker, statin, and ACEI/ARBs on discharge were 94.8%, 64.5%, 83.5%, and 61.4%, respectively. Multivariate analysis showed that prior use of each therapy was an independent predictor of prescription of the same therapy on discharge: aspirin (odds ratio (OR) = 4.8, 95% CI = 1.9-12.3, P < 0.01), beta-blocker (OR = 2.5, 95% CI = 1.8-3.4, P < 0.01); statin (OR = 8.3, 95% CI = 0.4-15.7, P < 0.01), and ACEI/ARBs (OR = 2.9, 95% CI = 2.0-4.3, P < 0.01). Passive continuation of prior medication was associated with higher 1-year mortality rates than active initiation in treatment-naïve patients (aspirin (13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), and statins (11.0% vs. 4.6%); all P < 0.01). Overall, the use of secondary prevention medication for AMI was suboptimal. Our findings suggested that the practice of passive continuation of prior medication was prevalent and associated with adverse clinical outcomes compared to active initiation of secondary preventive therapies for acute myocardial infarction during the index hospitalization.
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Affiliation(s)
- Nancy Xurui Huang
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - John E. Sanderson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Fang Fang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Cheuk-Man Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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17
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Kovács MG, Kovács ZZA, Varga Z, Szűcs G, Freiwan M, Farkas K, Kővári B, Cserni G, Kriston A, Kovács F, Horváth P, Földesi I, Csont T, Kahán Z, Sárközy M. Investigation of the Antihypertrophic and Antifibrotic Effects of Losartan in a Rat Model of Radiation-Induced Heart Disease. Int J Mol Sci 2021; 22:12963. [PMID: 34884782 PMCID: PMC8657420 DOI: 10.3390/ijms222312963] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022] Open
Abstract
Radiation-induced heart disease (RIHD) is a potential late side-effect of thoracic radiotherapy resulting in left ventricular hypertrophy (LVH) and fibrosis due to a complex pathomechanism leading to heart failure. Angiotensin-II receptor blockers (ARBs), including losartan, are frequently used to control heart failure of various etiologies. Preclinical evidence is lacking on the anti-remodeling effects of ARBs in RIHD, while the results of clinical studies are controversial. We aimed at investigating the effects of losartan in a rat model of RIHD. Male Sprague-Dawley rats were studied in three groups: (1) control, (2) radiotherapy (RT) only, (3) RT treated with losartan (per os 10 mg/kg/day), and were followed for 1, 3, or 15 weeks. At 15 weeks post-irradiation, losartan alleviated the echocardiographic and histological signs of LVH and fibrosis and reduced the overexpression of chymase, connective tissue growth factor, and transforming growth factor-beta in the myocardium measured by qPCR; likewise, the level of the SMAD2/3 protein determined by Western blot decreased. In both RT groups, the pro-survival phospho-AKT/AKT and the phospho-ERK1,2/ERK1,2 ratios were increased at week 15. The antiremodeling effects of losartan seem to be associated with the repression of chymase and several elements of the TGF-β/SMAD signaling pathway in our RIHD model.
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Affiliation(s)
- Mónika Gabriella Kovács
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Zsuzsanna Z. A. Kovács
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Zoltán Varga
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (Z.V.); (Z.K.)
| | - Gergő Szűcs
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Marah Freiwan
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Katalin Farkas
- Department of Laboratory Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (K.F.); (I.F.)
| | - Bence Kővári
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (B.K.); (G.C.)
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (B.K.); (G.C.)
| | - András Kriston
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research Network, H-6726 Szeged, Hungary; (A.K.); (F.K.); (P.H.)
- Single-Cell Technologies Ltd., H-6726 Szeged, Hungary
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FIN-00014 Helsinki, Finland
| | - Ferenc Kovács
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research Network, H-6726 Szeged, Hungary; (A.K.); (F.K.); (P.H.)
- Single-Cell Technologies Ltd., H-6726 Szeged, Hungary
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FIN-00014 Helsinki, Finland
| | - Péter Horváth
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research Network, H-6726 Szeged, Hungary; (A.K.); (F.K.); (P.H.)
- Single-Cell Technologies Ltd., H-6726 Szeged, Hungary
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FIN-00014 Helsinki, Finland
| | - Imre Földesi
- Department of Laboratory Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (K.F.); (I.F.)
| | - Tamás Csont
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Zsuzsanna Kahán
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (Z.V.); (Z.K.)
| | - Márta Sárközy
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
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18
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Jiménez-Blanco Bravo M, Valle A, Gayán Ordás J, Del Prado Díaz S, Cordero Pereda D, Morillas Climent H, Bascompte Claret R, Seller Moya J, Zamorano Gómez JL, Alonso Salinas GL. Safety and Efficacy of the Combination of Sacubitril/Valsartan and SGLT2i in HFrEF Patients (SECSI Registry). J Cardiovasc Pharmacol 2021; 78:e662-e668. [PMID: 34321396 DOI: 10.1097/fjc.0000000000001111] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Recent studies have proven benefit of SGLT2i drugs in patients with heart failure with reduced ejection fraction (HFrEF), but their safety when combined with angiotensin-neprilysin inhibitor (ARNI) has not been established. The Safety and Efficacy of the Combination of Sacubitril/Valsartan and SGLT2i in HFrEF Patients registry was conducted to address this issue. SECSI registry is a consecutive, observational, retrospective, multicentre study conducted in 3 Heart Failure Units in Spain. It included 144 HFrEF patients who were treated with ARNI and iSGLT2. Data were collected at baseline, month 2, and month 6. The primary endpoint was the estimated glomerular filtration rate (eGFR), after the initiation of ARNI and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Secondary endpoints included potassium levels and functional class (New York Heart Association class). There were 3 prespecified subgroup analyses: Elderly patients (≥70 years), patients with chronic kidney disease (KDIGO classification G3), and the sequence of drug initiation. Mean age was 69.9 ± 10.1 years, and 110 (76.4%) were men. Left ventricular ejection fraction was 32 ± 7.8%, and most patients were symptomatic [123 (87.2%) New York Heart Association II/III/IV]. eGFR decreased at month 2 and this trend was maintained at month 6 [eGFR baseline 68.5 ± 17.3, month 2 62 ± 19.7 and month 6 64.7 ± 8.6 mL/min/1.73 m2 (P < 0.01 for both)]. In prespecified analysis, elder patients and those who simultaneously initiate both treatments showed the steeper decrease in eGFR. To conclude, co-administration of SGLT2i and ARNI in routine care in HFrEF patients produced a slight decrease in eGFR at 6 months of follow-up. This decrease was especially significant in elder patients and those who initiate both drugs simultaneously.
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Affiliation(s)
| | - Alfonso Valle
- Cardiology Department, Hospital de Dénia-Marina Salud, Dénia, Spain
| | - Jara Gayán Ordás
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - David Cordero Pereda
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain ; and
| | | | - Ramón Bascompte Claret
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - José Luis Zamorano Gómez
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain ; and
| | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Cardiology Department, Hospital de Navarra, Pamplona, Spain
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Rodriguez R, Lee AY, Godoy-Lugo JA, Martinez B, Ohsaki H, Nakano D, Parkes DG, Nishiyama A, Vázquez-Medina JP, Ortiz RM. Chronic AT 1 blockade improves hyperglycemia by decreasing adipocyte inflammation and decreasing hepatic PCK1 and G6PC1 expression in obese rats. Am J Physiol Endocrinol Metab 2021; 321:E714-E727. [PMID: 34658252 PMCID: PMC8782654 DOI: 10.1152/ajpendo.00584.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2020] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022]
Abstract
Inappropriate activation of the renin-angiotensin system decreases glucose uptake in peripheral tissues. Chronic angiotensin receptor type 1 (AT1) blockade (ARB) increases glucose uptake in skeletal muscle and decreases the abundance of large adipocytes and macrophage infiltration in adipose. However, the contributions of each tissue to the improvement in hyperglycemia in response to AT1 blockade are not known. Therefore, we determined the static and dynamic responses of soleus muscle, liver, and adipose to an acute glucose challenge following the chronic blockade of AT1. We measured adipocyte morphology along with TNF-α expression, F4/80- and CD11c-positive cells in adipose and measured insulin receptor (IR) phosphorylation and AKT phosphorylation in soleus muscle, liver, and retroperitoneal fat before (T0), 60 (T60) and 120 (T120) min after an acute glucose challenge in the following groups of male rats: 1) Long-Evans Tokushima Otsuka (LETO; lean control; n = 5/time point), 2) obese Otsuka Long Evans Tokushima Fatty (OLETF; n = 7 or 8/time point), and 3) OLETF + ARB (ARB; 10 mg olmesartan/kg/day; n = 7 or 8/time point). AT1 blockade decreased adipocyte TNF-α expression and F4/80- and CD11c-positive cells. In retroperitoneal fat at T60, IR phosphorylation was 155% greater in ARB than in OLETF. Furthermore, in retroperitoneal fat AT1 blockade increased glucose transporter-4 (GLUT4) protein expression in ARB compared with OLETF. IR phosphorylation and AKT phosphorylation were not altered in the liver of OLETF, but AT1 blockade decreased hepatic Pck1 and G6pc1 mRNA expressions. Collectively, these results suggest that chronic AT1 blockade improves obesity-associated hyperglycemia in OLETF rats by improving adipocyte function and by decreasing hepatic glucose production via gluconeogenesis.NEW & NOTEWORTHY Inappropriate activation of the renin-angiotensin system increases adipocyte inflammation contributing to the impairment in adipocyte function and increases hepatic Pck1 and G6pc1 mRNA expression in response to a glucose challenge. Ultimately, these effects may contribute to the development of glucose intolerance.
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Affiliation(s)
- Ruben Rodriguez
- Department of Molecular & Cellular Biology, University of California, Merced, California
| | - Andrew Y Lee
- Department of Molecular & Cellular Biology, University of California, Merced, California
| | - Jose A Godoy-Lugo
- Department of Molecular & Cellular Biology, University of California, Merced, California
| | - Bridget Martinez
- Department of Molecular & Cellular Biology, University of California, Merced, California
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan
| | | | - Akira Nishiyama
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan
| | | | - Rudy M Ortiz
- Department of Molecular & Cellular Biology, University of California, Merced, California
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20
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Park SH, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Angiotensin converting enzyme inhibitors versus angiotensin II type 1 receptor blockers in patients with acute myocardial infarction and prediabetes after successful implantation of newer-generation drug-eluting stents. Cardiol J 2021; 30:614-626. [PMID: 34622435 PMCID: PMC10508070 DOI: 10.5603/cj.a2021.0116] [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: 03/16/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Because limited data are available, the present study investigated 2-year major clinical outcomes after angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) therapy in patients with acute myocardial infarction (AMI) and prediabetes after successful implantation of newer-generation drug-eluting stents (DESs). METHODS Overall, 2932 patients with AMI and prediabetes were classified into two groups - the ACEIs group (n = 2059) and the ARBs group (n = 873). The primary endpoint was the occurrence of patient- -oriented composite outcome (POCO), defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization. The secondary endpoint was definite or probable stent thrombosis (ST). RESULTS The cumulative incidences of POCO (adjusted hazard ratio [aHR]: 1.020; 95% confidence interval [CI]: 0.740-1.404; p = 0.906), all-cause death (aHR: 1.394; 95% CI: 0.803-2.419; p = 0.238), Re-MI (aHR: 1.210; 95% CI: 0.626-2.340; p = 0.570), any repeat revascularization (aHR: 1.150; 95% CI: 0.713-1.855; p = 0.568), and ST (aHR: 1.736; 95% CI: 0.445-6.766; p = 0.427) were similar between the groups. These results were confirmed after propensity score-adjusted analysis. CONCLUSIONS In this study, patients with AMI and prediabetes who received ACEIs or ARBs showed comparable clinical outcomes during the 2-year follow-up period.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Inter nal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Inter nal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National Univer sity Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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21
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Zhan X, Chen W, Chen J, Lei C, Wei L. Telmisartan Mitigates High-Glucose-Induced Injury in Renal Glomerular Endothelial Cells (rGECs) and Albuminuria in Diabetes Mice. Chem Res Toxicol 2021; 34:2079-2086. [PMID: 34464088 DOI: 10.1021/acs.chemrestox.1c00159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/28/2022]
Abstract
Diabetic nephropathy (DN) is a common and severe complication of diabetes, impacting millions of people worldwide. High concentrations of serum glucose-associated injury of renal glomerular endothelial cells (rGECs) are involved in the DN pathogenesis. We found that exposure to high glucose increased the expression of angiotensin II type 1 receptor (AT1R) in human rGECs (hrGECs). To block the increased AT1R level, we used the newly developed antagonist Telmisartan. This study investigated whether Telmisartan possessed a beneficial effect against high-glucose-induced insults in hrGECs and explored the underlying mechanism. Our findings indicate that Telmisartan ameliorated high-glucose-induced mitochondrial dysfunction by increasing mitochondrial membrane potential. Also, Telmisartan attenuated oxidative stress by reducing the levels of two oxidative stress biomarkers 8-hydroxy-2 deoxyguanosine (8-OHDG) and malondialdehyde (MDA). Further, we found that Telmisartan prevented high-glucose-induced expression of NADPH oxidase 2 (NOX-2). Interestingly, exposure to high glucose resulted in the increased endothelial permeability of renal glomerular endothelial cells, which was mitigated by treatment with Telmisartan. Mechanistically, these effects are mediated by the MLCK/MLC-2/occludin signaling pathway. In the leptin-deficient db/db diabetic mouse model, we proved that Telmisartan treatment ameliorated the reduction of occludin and albuminuria. In conclusion, our findings demonstrate that Telmisartan possesses protective effects on high-glucose-induced injury to renal glomerular endothelial cells; its antagonizing of AT1R could be a potential therapeutic target in diabetic nephropathy.
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Affiliation(s)
- Xiaolin Zhan
- Department of Nephrology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei 435000, China
| | - Wei Chen
- Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Wuhan, Hubei 430000, China
| | - Jian Chen
- Department of Nephrology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei 435000, China
| | - Changjiang Lei
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, China
| | - Liqin Wei
- Department of Nephrology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei 435000, China
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22
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Piazza M, Hanssen NMJ, Persson F, Scheijen JL, van de Waarenburg MPH, van Greevenbroek MMJ, Rossing P, Hovind P, Stehouwer CDA, Parving H, Schalkwijk CG. Irbesartan treatment does not influence plasma levels of the dicarbonyls methylglyoxal, glyoxal and 3-deoxyglucosone in participants with type 2 diabetes and microalbuminuria: An IRMA2 sub-study. Diabet Med 2021; 38:e14405. [PMID: 32961617 PMCID: PMC8451908 DOI: 10.1111/dme.14405] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022]
Abstract
AIM Angiotensin receptor blockers (ARBs) reduce vascular complications in diabetes independently of blood pressure. Experimental studies suggested that ARBs may restore the detoxifying enzyme glyoxalase 1, thereby lowering dicarbonyls such as methylglyoxal. Human data on the effects of ARBs on plasma dicarbonyl levels are lacking. We investigated, in individuals with type 2 diabetes, whether irbesartan lowered plasma levels of the dicarbonyls methylglyoxal, glyoxal, 3-deoxyglucosone and their derived advanced glycation end products (AGEs), and increased d-lactate, reflecting greater methylglyoxal flux. METHODS We analysed a subset of the Irbesartan in Patients with T2D and Microalbuminuria (IRMA2) study. We measured plasma dicarbonyls methylglyoxal, glyoxal and 3-deoxyglucosone, free AGEs and d-lactate using ultra-performance liquid chromatography tandem mass-spectrometry (UPLC-MS/MS) in the treatment arm receiving 300 mg irbesartan (n = 121) and a placebo group (n = 101) at baseline and after 1 and 2 years. Effect of treatment was analysed with repeated measurements ANOVA. RESULTS There was a slight, but significant difference in baseline median methylglyoxal levels [placebo 1119 (907-1509) nmol/l vs. irbesartan 300 mg 1053 (820-1427) nmol/l], but no significant changes were observed in any of the plasma dicarbonyls over time in either group and there was no effect of irbesartan treatment on plasma free AGEs or d-lactate levels at either 1 or 2 years. CONCLUSION Irbesartan treatment does not change plasma levels of the dicarbonyls methylglyoxal, glyoxal and 3-deoxyglucosone, free AGEs or d-lactate in type 2 diabetes. This indicates that increased dicarbonyls in type 2 diabetes are not targetable by ARBs, and other approaches to lower systemic dicarbonyls are needed in type 2 diabetes. (Clinical Trial Registry No: #NCT00317915).
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Affiliation(s)
- M. Piazza
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
- Department of Medicine‐DIMED University of PaduaItaly
| | - N. M. J. Hanssen
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - F. Persson
- Steno Diabetes Center CopenhagenCopenhagenDenmark
| | - J. L. Scheijen
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - M. P. H. van de Waarenburg
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - M. M. J. van Greevenbroek
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - P. Rossing
- Steno Diabetes Center CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - P. Hovind
- Steno Diabetes Center CopenhagenCopenhagenDenmark
- Clinical Physiology and Nuclear MedicineBispebjerg HospitalCopenhagenDenmark
| | - C. D. A. Stehouwer
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
| | - H‐H. Parving
- Medical EndocrinologyUniversity Hospital of CopenhagenCopenhagenDenmark
| | - C. G. Schalkwijk
- Internal MedicineMaastricht University Medical CentreMaastrichtthe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastrichtthe Netherlands
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23
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Del Buono MG, Damonte JI, Trankle CR, Bhardwaj H, Markley R, Turlington J, Van Tassell BW, Salloum FN, Abbate A. Sacubitril/Valsartan for the Prevention and Treatment of Postinfarction Heart Failure: Ready to Use? J Cardiovasc Pharmacol 2021; 78:331-333. [PMID: 34225338 DOI: 10.1097/fjc.0000000000001103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marco G Del Buono
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Juan I Damonte
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
- Department of Hemodynamics and Interventional Cardiology, Hospital Italiano de Buenos Aires, Argentina; and
| | - Cory R Trankle
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
| | - Hem Bhardwaj
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
| | - Roshanak Markley
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
| | - Jeremy Turlington
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
| | - Benjamin W Van Tassell
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
- Virginia Commonwealth University School of Pharmacy, Virginia Commonwealth University, Richmond, VA
| | - Fadi N Salloum
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
| | - Antonio Abbate
- Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Richmond, VA
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24
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Rotbain Curovic V, Magalhães P, He T, Hansen TW, Mischak H, Rossing P. Urinary peptidome and diabetic retinopathy in the DIRECT-Protect 1 and 2 trials. Diabet Med 2021; 38:e14634. [PMID: 34228837 DOI: 10.1111/dme.14634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Given the association of diabetic retinopathy (DR) and kidney disease, we investigated the urinary peptidome to presence and deterioration of DR in a post hoc analysis of trials investigating the effect of candesartan on progression of DR in type 1 and type 2 diabetes, respectively. METHODS Baseline urinary peptidomic analysis was performed on a random selection of 783 and 792 subjects in two randomized controlled trials, DIRECT-Protect 1 and 2, respectively. End points were two-step (RET2) and three-step (RET3) change in Early Treatment of Diabetic Retinopathy Study protocol (ETDRS) defined level. Peptide levels were correlated to baseline EDTRS level in a discovery set of 2/3 of the participants from DIRECT-Protect 1. The identified peptides were then validated cross-sectionally in the remaining 1/3 from DIRECT-Protect 1. Thereafter, peptides identified in the discovery set were assessed in the entire DIRECT-Protect 1 and 2 cohorts and significant peptides were tested longitudinally. RESULTS Follow-up ranged 4.0-4.7 years. 24 peptides were associated with baseline DR in the discovery set. COL3A1 (seq: NTG~) and COL4A1 (seq: DGA~) were associated with baseline DR in the validation set (Rho: -.223, p < 0.001 and Rho: -.141, p = 0.024). Neither was significantly associated with end points. Assessing the 24 identified peptides in the entire cohorts, several collagen peptides were associated with baseline DR and end points; however, there was no overlap across diabetes types. CONCLUSIONS We identified several urinary peptides (mainly collagen) associated with the presence of DR, however they could not be conclusively associated with worsening of DR.
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Affiliation(s)
| | | | - Tianlin He
- Mosaiques Diagnostics, Hannover, Germany
- Institute for Molecular Cardiovascular Research, University of Aachen, Aachen, Germany
| | | | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
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Zanza C, Tassi MF, Romenskaya T, Piccolella F, Abenavoli L, Franceschi F, Piccioni A, Ojetti V, Saviano A, Canonico B, Montanari M, Zamai L, Artico M, Robba C, Racca F, Longhitano Y. Lock, Stock and Barrel: Role of Renin-Angiotensin-Aldosterone System in Coronavirus Disease 2019. Cells 2021; 10:1752. [PMID: 34359922 PMCID: PMC8306543 DOI: 10.3390/cells10071752] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Since the end of 2019, the medical-scientific community has been facing a terrible pandemic caused by a new airborne viral agent known as SARS-CoV2. Already in the early stages of the pandemic, following the discovery that the virus uses the ACE2 cell receptor as a molecular target to infect the cells of our body, it was hypothesized that the renin-angiotensin-aldosterone system was involved in the pathogenesis of the disease. Since then, numerous studies have been published on the subject, but the exact role of the renin-angiotensin-aldosterone system in the pathogenesis of COVID-19 is still a matter of debate. RAAS represents an important protagonist in the pathogenesis of COVID-19, providing the virus with the receptor of entry into host cells and determining its organotropism. Furthermore, following infection, the virus is able to cause an increase in plasma ACE2 activity, compromising the normal function of the RAAS. This dysfunction could contribute to the establishment of the thrombo-inflammatory state characteristic of severe forms of COVID-19. Drugs targeting RAAS represent promising therapeutic options for COVID-19 sufferers.
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Affiliation(s)
- Christian Zanza
- Department of Emergency Medicine, Foundation of Policlinico Agostino Gemelli-IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy; (F.F.); (A.P.); (V.O.); (A.S.)
- Department of Anesthesia and Critical Care, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (T.R.); (F.P.); (F.R.); (Y.L.)
- Foundation Ospedale Alba-Bra and Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, 12051 Verduno, Italy
| | - Michele Fidel Tassi
- Department of Emergency Medicine, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Tatsiana Romenskaya
- Department of Anesthesia and Critical Care, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (T.R.); (F.P.); (F.R.); (Y.L.)
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (T.R.); (F.P.); (F.R.); (Y.L.)
| | - Ludovico Abenavoli
- Department of Health Sciences, University Magna Graecia, 88100 Catanzaro, Italy;
| | - Francesco Franceschi
- Department of Emergency Medicine, Foundation of Policlinico Agostino Gemelli-IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy; (F.F.); (A.P.); (V.O.); (A.S.)
| | - Andrea Piccioni
- Department of Emergency Medicine, Foundation of Policlinico Agostino Gemelli-IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy; (F.F.); (A.P.); (V.O.); (A.S.)
| | - Veronica Ojetti
- Department of Emergency Medicine, Foundation of Policlinico Agostino Gemelli-IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy; (F.F.); (A.P.); (V.O.); (A.S.)
| | - Angela Saviano
- Department of Emergency Medicine, Foundation of Policlinico Agostino Gemelli-IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy; (F.F.); (A.P.); (V.O.); (A.S.)
| | - Barbara Canonico
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (B.C.); (M.M.); (L.Z.)
| | - Mariele Montanari
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (B.C.); (M.M.); (L.Z.)
| | - Loris Zamai
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (B.C.); (M.M.); (L.Z.)
- National Institute for Nuclear Physics (INFN)-Gran Sasso National Laboratory (LNGS), 67100 Assergi L’Aquila, Italy
| | - Marco Artico
- Department of Sensory Organs, Sapienza University of Rome, 00185 Rome, Italy;
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy;
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (T.R.); (F.P.); (F.R.); (Y.L.)
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (T.R.); (F.P.); (F.R.); (Y.L.)
- Foundation Ospedale Alba-Bra and Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, 12051 Verduno, Italy
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Stătescu C, Enachi Ș, Ureche C, Țăpoi L, Anghel L, Șalaru D, Pleșoianu C, Bostan M, Marcu D, Ovanez Balasanian M, Sascău RA. Pushing the Limits of Medical Management in HCM: A Review of Current Pharmacological Therapy Options. Int J Mol Sci 2021; 22:ijms22137218. [PMID: 34281272 PMCID: PMC8268685 DOI: 10.3390/ijms22137218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiac disease with a highly variable phenotypic expression, ranging from asymptomatic to drug refractory heart failure (HF) presentation. Pharmacological therapy is the first line of treatment, but options are currently limited to nonspecific medication like betablockers or calcium channel inhibitors, with frequent suboptimal results. While being the gold standard practice for the management of drug refractory HCM patients, septal reduction therapy (SRT) remains an invasive procedure with associated surgical risks and it requires the expertise of the operating centre, thus limiting its accessibility. It is therefore with high interest that researchers look for pharmacological alternatives that could provide higher rates of success. With new data gathering these past years as well as the development of a new drug class showing promising results, this review provides an up-to-date focused synthesis of existing medical treatment options and future directions for HCM pharmacological treatment.
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Affiliation(s)
- Cristian Stătescu
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefana Enachi
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Correspondence: ; Tel.: +40-749-630-641
| | - Carina Ureche
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Țăpoi
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
| | - Larisa Anghel
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Delia Șalaru
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Carmen Pleșoianu
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mădălina Bostan
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragoș Marcu
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mircea Ovanez Balasanian
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Radu Andy Sascău
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Carol I Boulevard No. 50, 700503 Iași, Romania; (C.S.); (C.U.); (L.Ț.); (L.A.); (D.Ș.); (C.P.); (M.B.); (D.M.); (M.O.B.); (R.A.S.)
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Liu CH, Sung PS, Li YR, Huang WK, Lee TW, Huang CC, Lee TH, Chen TH, Wei YC. Telmisartan use and risk of dementia in type 2 diabetes patients with hypertension: A population-based cohort study. PLoS Med 2021; 18:e1003707. [PMID: 34280191 PMCID: PMC8289120 DOI: 10.1371/journal.pmed.1003707] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs) may have protective effects against dementia occurrence in patients with hypertension (HTN). However, whether telmisartan, an ARB with peroxisome proliferator-activated receptor γ (PPAR-γ)-modulating effects, has additional benefits compared to other ARBs remains unclear. METHODS AND FINDINGS Between 1997 and 2013, 2,166,944 type 2 diabetes mellitus (T2DM) patients were identified from the National Health Insurance Research Database of Taiwan. Patients with HTN using ARBs were included in the study. Patients with a history of stroke, traumatic brain injury, or dementia were excluded. Finally, 65,511 eligible patients were divided into 2 groups: the telmisartan group and the non-telmisartan ARB group. Propensity score matching (1:4) was used to balance the distribution of baseline characteristics and medications. The primary outcome was the diagnosis of dementia. The secondary outcomes included the diagnosis of Alzheimer disease and occurrence of symptomatic ischemic stroke (IS), any IS, and all-cause mortality. The risks between groups were compared using a Cox proportional hazard model. Statistical significance was set at p < 0.05. There were 2,280 and 9,120 patients in the telmisartan and non-telmisartan ARB groups, respectively. Patients in the telmisartan group had a lower risk of dementia diagnosis (telmisartan versus non-telmisartan ARBs: 2.19% versus 3.20%; HR, 0.72; 95% CI, 0.53 to 0.97; p = 0.030). They also had lower risk of dementia diagnosis with IS as a competing risk (subdistribution HR, 0.70; 95% CI, 0.51 to 0.95; p = 0.022) and with all-cause mortality as a competing risk (subdistribution HR, 0.71; 95% CI, 0.53 to 0.97; p = 0.029). In addition, the telmisartan users had a lower risk of any IS (6.84% versus 8.57%; HR, 0.79; 95% CI, 0.67 to 0.94; p = 0.008) during long-term follow-up. Study limitations included potential residual confounding by indication, interpretation of causal effects in an observational study, and bias caused by using diagnostic and medication codes to represent real clinical data. CONCLUSIONS The current study suggests that telmisartan use in hypertensive T2DM patients may be associated with a lower risk of dementia and any IS events in an East-Asian population.
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Affiliation(s)
- Chi-Hung Liu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yan-Rong Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Kuan Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tay-Wey Lee
- Biostatistical Consultation Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung, Taiwan
- * E-mail: (THC); (YCW)
| | - Yi-Chia Wei
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- * E-mail: (THC); (YCW)
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Heck SL, Mecinaj A, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, Gravdehaug B, Røsjø H, Steine K, Geisler J, Gulati G, Omland T. Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): Extended Follow-Up of a 2×2 Factorial, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Candesartan and Metoprolol. Circulation 2021; 143:2431-2440. [PMID: 33993702 PMCID: PMC8212877 DOI: 10.1161/circulationaha.121.054698] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adjuvant breast cancer therapy containing anthracyclines with or without anti-human epidermal growth factor receptor-2 antibodies and radiotherapy is associated with cancer treatment-related cardiac dysfunction. In the PRADA trial (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy), concomitant treatment with the angiotensin receptor blocker candesartan attenuated the reduction in left ventricular ejection fraction (LVEF) in women receiving treatment for breast cancer, whereas the β-blocker metoprolol attenuated the increase in cardiac troponins. This study aimed to assess the long-term effects of candesartan and metoprolol or their combination to prevent a reduction in cardiac function and myocardial injury. METHODS In this 2×2 factorial, randomized, placebo-controlled, double-blind, single-center trial, patients with early breast cancer were assigned to concomitant treatment with candesartan cilexetil, metoprolol succinate, or matching placebos. Target doses were 32 and 100 mg, respectively. Study drugs were discontinued after adjuvant therapy. All 120 validly randomized patients were included in the intention-to-treat analysis. The primary outcome measure was change in LVEF assessed by cardiovascular magnetic resonance imaging from baseline to extended follow-up. Secondary outcome measures included changes in left ventricular volumes, echocardiographic peak global longitudinal strain, and circulating cardiac troponin concentrations. RESULTS A small decline in LVEF but no significant between-group differences were observed from baseline to extended follow-up, at a median of 23 months (interquartile range, 21 to 28 months) after randomization (candesartan, 1.7% [95% CI, 0.5 to 2.8]; no candesartan, 1.8% [95% CI, 0.6 to 3.0]; metoprolol, 1.6% [95% CI, 0.4 to 2.7]; no metoprolol, 1.9% [95% CI, 0.7 to 3.0]). Candesartan treatment during adjuvant therapy was associated with a significant reduction in left ventricular end-diastolic volume compared with the noncandesartan group (P=0.021) and attenuated decline in global longitudinal strain (P=0.046) at 2 years. No between-group differences in change in cardiac troponin I and T concentrations were observed. CONCLUSIONS Anthracycline-containing adjuvant therapy for early breast cancer was associated with a decline in LVEF during extended follow-up. Candesartan during adjuvant therapy did not prevent reduction in LVEF at 2 years, but was associated with modest reduction in left ventricular end-diastolic volume and preserved global longitudinal strain. These results suggest that a broadly administered cardioprotective approach may not be required in most patients with early breast cancer without preexisting cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01434134.
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Affiliation(s)
- Siri Lagethon Heck
- Department of Diagnostic Imaging (S.L.H.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Albulena Mecinaj
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Anne Hansen Ree
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases (P.H.), Oslo University Hospital, Ullevål, Norway
| | - Jeanette Schulz-Menger
- Department of Cardiology, Charité Campus Buch, Universitätsmedizin Berlin, Germany (J.S.-M.)
- HELIOS Clinics, Berlin, Germany (J.S.-M.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway (M.W.F.)
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, (B.G.), Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Kjetil Steine
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Jürgen Geisler
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Geeta Gulati
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
- Department of Cardiology, Division of Medicine (G.G.), Oslo University Hospital, Ullevål, Norway
| | - Torbjørn Omland
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
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Ling QS, Zhang SL, Tian JS, Cheng MH, Liu AJ, Fu FH, Liu JG, Miao CY. Allisartan isoproxil reduces mortality of stroke-prone rats and protects against cerebrovascular, cardiac, and aortic damage. Acta Pharmacol Sin 2021; 42:871-884. [PMID: 34002042 PMCID: PMC8149727 DOI: 10.1038/s41401-021-00684-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/17/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke is a common cause of death and disability. Allisartan isoproxil (ALL) is a new angiotensin II receptor blocker and a new antihypertensive drug discovered and developed in China. In the present study we investigated the therapeutic effects of ALL in stroke-prone renovascular hypertensive rats (RHR-SP) and the underlying mechanisms. The model rats were generated via two-kidney two-clip (2K2C) surgery, which led to 100% of hypertension, 100% of cerebrovascular damage as well as 100% of mortality 1 year after the surgery. Administration of ALL (30 mg · kg-1 · d-1 in diet, for 55 weeks) significantly decreased stroke-related death and prolonged lifespan in RHR-SP, but the survival ALL-treated RHR-SP remained of hypertension and cardiovascular hypertrophy compared with sham-operated normal controls. In addition to cardiac, and aortic protection, ALL treatment for 10 or 12 weeks significantly reduced cerebrovascular damage incidence and scoring, along with a steady reduction of blood pressure (BP) in RHR-SP. Meanwhile, it significantly decreased serum aldosterone and malondialdehyde levels and cerebral NAD(P)H oxidase expressions in RHR-SP. We conducted 24 h continuous BP recording in conscious freely moving RHR-SP, and found that a single intragastric administration of ALL produced a long hypotensive effect lasting for at least 12 h on systolic BP. Taken together, our results in RHR-SP demonstrate that ALL can be used for stroke prevention via BP reduction and organ protection, with the molecular mechanisms related to inhibition of angiotensin-aldosterone system and oxidative stress. This study also provides a valuable scoring for evaluation of cerebrovascular damage and drug efficacy.
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Affiliation(s)
- Qi-Sheng Ling
- School of Pharmacy, Yantai University, Yantai, 264005, China
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Sai-Long Zhang
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Jia-Sheng Tian
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Ming-He Cheng
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Ai-Jun Liu
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Feng-Hua Fu
- School of Pharmacy, Yantai University, Yantai, 264005, China
| | - Jian-Guo Liu
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Chao-Yu Miao
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China.
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Tehrani AY, White Z, Milad N, Esfandiarei M, Seidman MA, Bernatchez P. Blood pressure-independent inhibition of Marfan aortic root widening by the angiotensin II receptor blocker valsartan. Physiol Rep 2021; 9:e14877. [PMID: 34042309 PMCID: PMC8157789 DOI: 10.14814/phy2.14877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022] Open
Abstract
Marfan syndrome (MFS) is a genetic disorder that results in accelerated aortic root widening and aneurysm. However, management of MFS patients with blood pressure (BP)-lowering medications, such as angiotensin II (AngII) receptor blocker (ARB) losartan, continues to pose challenges due to their questionable efficacy at attenuating the rate of aortic root widening in patients. Herein we investigate the anti-aortic root widening effects of a sub-BP-lowering dose valsartan, an ARB previously linked to non-BP lowering anti-remodeling effects. Despite absence of BP-lowering effects, valsartan attenuated MFS aortic root widening by 75.9%, which was similar to a hypotensive dose of losartan (79.4%) when assessed by ultrasound echocardiography. Medial thickening, elastic fiber fragmentation, and phospho-ERK signaling were also inhibited to a similar degree with both treatments. Valsartan and losartan decreased vascular contractility ex vivo between 60% and 80%, in a nitric oxide (NO)-sensitive fashion. Valsartan increased acetylcholine (Ach)-induced vessel relaxation and phospho-eNOS levels in the aortic vessel supporting BP-independent activation of protective endothelial function, which is critical to ARB-mediated aortic root stability. This study supports the concept of achieving aortic root stability with valsartan in absence of BP-lowering effects, which may help address efficacy and compliance issues with losartan-based MFS patient management.
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Affiliation(s)
- Arash Y. Tehrani
- Centre for Heart Lung InnovationUniversity of British ColumbiaVancouverBCCanada
- Department of AnesthesiologyPharmacology & TherapeuticsUniversity of British ColumbiaVancouverBCCanada
| | - Zoe White
- Centre for Heart Lung InnovationUniversity of British ColumbiaVancouverBCCanada
- Department of AnesthesiologyPharmacology & TherapeuticsUniversity of British ColumbiaVancouverBCCanada
| | - Nadia Milad
- Centre for Heart Lung InnovationUniversity of British ColumbiaVancouverBCCanada
- Department of AnesthesiologyPharmacology & TherapeuticsUniversity of British ColumbiaVancouverBCCanada
| | - Mitra Esfandiarei
- Department of AnesthesiologyPharmacology & TherapeuticsUniversity of British ColumbiaVancouverBCCanada
- Department of Biomedical SciencesCollege of Graduate StudiesMidwestern UniversityGlendaleArizonaUSA
| | - Michael A. Seidman
- Centre for Heart Lung InnovationDepartment of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Pascal Bernatchez
- Centre for Heart Lung InnovationUniversity of British ColumbiaVancouverBCCanada
- Department of AnesthesiologyPharmacology & TherapeuticsUniversity of British ColumbiaVancouverBCCanada
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Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a dangerous prevalent smoking-related disease characterized by abnormal inflammation and oxidative stress and expected to be the third cause of death in the world next decade. Corticosteroids have low effects in decreasing numbers of inflammatory mediators specifically in long-term use. Our study designed to investigate the possible protective effects of combined dexamethasone (Dex) (2mg/kg) and losartan (Los) (30mg/kg angiotensin receptor blocker, it possesses antioxidant and anti-inflammatory properties in lung injury in mice) against cigarette -smoke (CS) induced COPD in rats compared with dexamethasone and losartan. Male Sprague Dawley rats (N = 40) divided into five groups (n = 8): control group, CS group, Dex group, Los group, and Dex +Los group. COPD induced in rats by CS exposure twice daily for 10 weeks. After the specified treatment period, bronchoalveolar lavage fluid (BALF) and lung tissue were collected for measurement of SOD, NO, MDA, ICAM-, MMP-9, CRP, NF-κB and histopathology scoring. Our results indicated that Los+Dex significantly prevent CS-induced COPD emphysema, congested alveoli, and elevation of lung injury parameters in BALF. They also showed a significant decrease in MDA, ICAM-1, MMP-9, CRP, and NF-κB and a significant increase in SOD and NO. In conclusion, adding Los to Dex potentiating their activity in inhibition the progression of COPD based on its activity on oxidative stress, inflammation, and NF-κB protein expression.
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Affiliation(s)
- Samia S Sokar
- Professor of Pharmacology and Toxicology, 68904Faculty of Pharmacy, Tanta University, Egypt
| | | | - Enass Y Osman
- Department of Pharmacology and Toxicology, 68904Faculty of Pharmacy, Tanta University, Egypt
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Zou L, Chen G, Zhou Y, Ye W, Wen Y, Chen L, Li X. Continuous hypergammaglobulinemia and proteinuria after the recovery of the visceral Leishmaniasis: a case report. BMC Infect Dis 2021; 21:124. [PMID: 33509123 PMCID: PMC7844912 DOI: 10.1186/s12879-021-05819-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney involvement of visceral Leishmaniasis is previously reported, but knowledge is limited. Hypergammaglobulinemia is common in visceral leishmaniasis patients. Whether hypergammaglobulinemia after leishmaniasis depletion can cause kidney injury is not well reported yet. CASE PRESENTATION We reported a patient who recovered from visceral Leishmaniasis but showed persistent hypergammaglobulinemia and elevated urinary protein. Kidney biopsy showed glomerular hypertrophy with mild segmental mesangial proliferation without tubulointerstitial involvement in light microscopy. No immune complex deposit was found in the mesangial area by neither immunofluorescent staining nor electronic microscope. Increased lysosomes were observed in proximal tubules by electronic microscope. Valsartan was administered to decrease urinary protein, and no immune-suppressive therapy was added. The urinary protein and serum IgG level gradually dropped, and serum creatinine level remained stable during three- month follow up. CONCLUSIONS Hypergammaglobulinemia is unlikely to cause renal structural or functional damage in the short term. Angiotensin blockade significantly reduced urine protein, with a minor effect on IgG elimination.
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Affiliation(s)
- Linfeng Zou
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Gang Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Yangzhong Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Ye
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yubin Wen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Bolotova O, Yoo J, Chaudhri I, Marcos LA, Sahib H, Koraishy FM, Skopicki H, Ahmad S, Mallipattu SK. Safety, tolerability, and outcomes of losartan use in patients hospitalized with SARS-CoV-2 infection: A feasibility study. PLoS One 2020; 15:e0244708. [PMID: 33378401 PMCID: PMC7773257 DOI: 10.1371/journal.pone.0244708] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Retrospective studies on the use of Renin-Angiotensin-Aldosterone System blockade in patients with Coronavirus Disease 2019 (COVID-19) have been informative but conflicting, and prospective studies are required to demonstrate the safety, tolerability, and outcomes of initiating these agents in hospitalized patients with COVID-19 and hypertension. METHODS AND FINDINGS This is a single center feasibility study encompassing two cohorts: (1) prospective cohort (April 21, 2020 to May 29, 2020) and (2) retrospective cohort (March 7, 2020 to April 1, 2020) of hospitalized patients with real-time polymerase chain reaction (PCR) positive SARS-CoV-2 by nasopharyngeal swab. Key inclusion criteria include BP > 130/80 and a requirement of supplemental oxygen with FiO2 of 25% or higher to maintain SpO2 > 92%. Key exclusion criteria included hyperkalemia and acute kidney injury (AKI) at the time of enrollment. Prospective cohort consisted of de novo initiation of losartan and continuation for a minimum of 7 days and assessed for adverse events (AKI, hyperkalemia, transaminitis, hypotension) and clinical outcomes (change in SpO2/FiO2 and inflammatory markers, need for ICU admission and mechanical ventilation). Retrospective cohort consisted of continuation of losartan (prior-to-hospitalization) and assessment of similar outcomes. In the prospective cohort, a total of 250 hospitalized patients were screened and inclusion/exclusion criteria were met in 16/250 patients and in the retrospective cohort, a total of 317 hospitalized patients were screened and inclusion/exclusion criteria were met in 14/317 patients. Most common adverse event was hypotension, leading to discontinuation in 3/16 (19%) and 2/14 (14%) patients in the prospective and retrospective cohort. No patients developed AKI in the prospective cohort as compared to 1/14 (7%) patients in the retrospective cohort, requiring discontinuation of losartan. Hyperkalemia occurred in 1/16 (6%) and 0/14 patients in the prospective and retrospective cohorts, respectively. In the prospective cohort, 3/16 (19%) and 2/16 (13%) patients required ICU admission and mechanical ventilation. In comparison, 3/14 (21%) required ICU admission and mechanical ventilation in the retrospective cohort. A majority of patients in both cohorts (14/16 (88%) and 13/14 (93%) patients from the prospective and retrospective cohort) were discharged alive from the hospital. A total of 9/16 (prospective) and 5/14 (retrospective) patients completed a minimum 7 days of losartan. In these 9 patients in the prospective cohort, a significant improvement in SpO2/FiO2 ratio was observed from day 1 to 7. No significant changes in inflammatory markers (initiation, peak, and day 7) were observed in either cohort. CONCLUSION In this pilot study we demonstrate that losartan was well-tolerated among hospitalized patients with COVID-19 and hypertension. We also demonstrate the feasibility of patient recruitment and the appropriate parameters to assess the outcomes and safety of losartan initiation or continuation, which provides a framework for future randomized clinical trials.
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Affiliation(s)
- Olena Bolotova
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Jeanwoo Yoo
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Imran Chaudhri
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Luis A. Marcos
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Haseena Sahib
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Farrukh M. Koraishy
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Hal Skopicki
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Sahar Ahmad
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
| | - Sandeep K. Mallipattu
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States of America
- Renal Section, Northport VA Medical Center, Northport, NY, United States of America
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Russell JA, Marshall JC, Slutsky A, Murthy S, Sweet D, Lee T, Singer J, Patrick DM, Du B, Peng Z, Cheng M, Burns KD, Harhay MO. Study protocol for a multicentre, prospective cohort study of the association of angiotensin II type 1 receptor blockers on outcomes of coronavirus infection. BMJ Open 2020; 10:e040768. [PMID: 33293316 PMCID: PMC7722825 DOI: 10.1136/bmjopen-2020-040768] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The COVID-19 epidemic grows and there are clinical trials of antivirals. There is an opportunity to complement these trials with investigation of angiotensin II type 1 receptor blockers (ARBs) because an ARB (losartan) was effective in murine influenza pneumonia. METHODS AND ANALYSIS Our innovative design includes: ARBs; alignment with the WHO Ordinal Scale (primary endpoint) to align with other COVID-19 trials; joint longitudinal analysis; and predictive biomarkers (angiotensins I, 1-7, II and ACE1 and ACE2). Our hypothesis is: ARBs decrease the need for hospitalisation, severity (need for ventilation, vasopressors, extracorporeal membrane oxygenation or renal replacement therapy) or mortality of hospitalised COVID-19 infected adults. Our two-pronged multicentre pragmatic observational cohort study examines safety and effectiveness of ARBs in (1) hospitalised adult patients with COVID-19 and (2) out-patients already on or not on ARBs. The primary outcome will be evaluated by ordinal logistic regression and main secondary outcomes by both joint longitudinal modelling analyses. We will compare rates of hospitalisation of ARB-exposed versus not ARB-exposed patients. We will also determine whether continuing ARBs or not decreases the primary outcome. Based on published COVID-19 cohorts, assuming 15% of patients are ARB-exposed, a total sample size of 497 patients can detect a proportional OR of 0.5 (alpha=0.05, 80% power) comparing WHO scale of ARB-exposed versus non-ARB-exposed patients. ETHICS AND DISSEMINATION This study has core institution approval (UBC Providence Healthcare Research Ethics Board) and site institution approvals (Health Research Ethics Board, University of Alberta; Comite d'etique de la recerche, CHU Sainte Justine (for McGill University and University of Sherbrook); Conjoint Health Research Ethics Board, University of Calgary; Queen's University Health Sciences & Affiliated Hospitals Research Ethics Board; Research Ethics Board, Sunnybrook Health Sciences Centre; Veritas Independent Research Board (for Humber River Hospital); Mount Sinai Hospital Research Ethics Board; Unity Health Toronto Research Ethics Board, St. Michael's Hospital). Results will be disseminated by peer-review publication and social media releases. TRIAL REGISTRATION NUMBER NCT04510623.
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Affiliation(s)
- James A Russell
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Arthur Slutsky
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Srinivas Murthy
- Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Sweet
- Emergency Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Terry Lee
- Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Patrick
- Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bin Du
- Medical ICU, Peking University, Beijing, China
| | - Zhiyong Peng
- Medicine, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Matthew Cheng
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kevin D Burns
- Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael O Harhay
- Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Meng J, Xiao G, Zhang J, He X, Ou M, Bi J, Yang R, Di W, Wang Z, Li Z, Gao H, Liu L, Zhang G. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect 2020; 9:757-760. [PMID: 32228222 PMCID: PMC7170368 DOI: 10.1080/22221751.2020.1746200] [Citation(s) in RCA: 442] [Impact Index Per Article: 110.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/13/2023]
Abstract
The dysfunction of the renin-angiotensin system (RAS) has been observed in coronavirus infection disease (COVID-19) patients, but whether RAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs), are associated with clinical outcomes remains unknown. COVID-19 patients with hypertension were enrolled to evaluate the effect of RAS inhibitors. We observed that patients receiving ACEI or ARB therapy had a lower rate of severe diseases and a trend toward a lower level of IL-6 in peripheral blood. In addition, ACEI or ARB therapy increased CD3 and CD8 T cell counts in peripheral blood and decreased the peak viral load compared to other antihypertensive drugs. This evidence supports the benefit of using ACEIs or ARBs to potentially contribute to the improvement of clinical outcomes of COVID-19 patients with hypertension.
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Affiliation(s)
- Juan Meng
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Shenzhen Bay Laboratory, Shenzhen, People’s Republic of China
| | - Guohui Xiao
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Shenzhen Bay Laboratory, Shenzhen, People’s Republic of China
| | - Juanjuan Zhang
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Xing He
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Min Ou
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Jing Bi
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Rongqing Yang
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Wencheng Di
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Zhaoqin Wang
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Zigang Li
- Shenzhen Bay Laboratory, Shenzhen, People’s Republic of China
| | - Hong Gao
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Lei Liu
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Guoliang Zhang
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Shenzhen Bay Laboratory, Shenzhen, People’s Republic of China
- Lead Contact
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Qiao Y, Shin JI, Chen TK, Sang Y, Coresh J, Vassalotti JA, Chang AR, Grams ME. Association of Albuminuria Levels With the Prescription of Renin-Angiotensin System Blockade. Hypertension 2020; 76:1762-1768. [PMID: 32981368 PMCID: PMC7666106 DOI: 10.1161/hypertensionaha.120.15956] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple clinical guidelines recommend an ACE (angiotensin-converting enzyme) inhibitor or angiotensin II receptor blocker (ARB) in patients with elevated albuminuria, which can be measured through urine albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio, or dipstick. However, how albuminuria test results relate to the prescription of ACE inhibitor/ARB is uncertain. We identified individuals with an ACR measurement between January 1, 2004, and June 30, 2018, and no contraindications or allergy to ACE inhibitor/ARB. We performed multivariable logistic regression analyses to evaluate the association between ACR level and prescription of ACE inhibitor/ARB within 6 months after the test. We applied similar methods to investigate the association of protein-to-creatinine ratio and dipstick measurement results with the prescription of ACE inhibitor/ARB. Among 67 237 individuals with an ACR measurement, 47.7% were already taking an ACE inhibitor or ARB at the time of first ACR measurement. Among the 35 138 individuals who were not on ACE inhibitor/ARB, those with higher ACR levels were more likely to be prescribed ACE inhibitor/ARB in the following 6 months, with steep increases in prescriptions until ACR 300 mg/g, after which the association plateaued. The majority (80.9%) of ACE inhibitor/ARB prescriptions were made by family medicine and internal medicine. A similar pattern held in the cohorts tested by protein-to-creatinine ratio and dipstick measurement. Our study provides evidence that albuminuria test results change patient care, suggesting that adherence to albuminuria testing is a key step in optimal medical management.
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Affiliation(s)
- Yao Qiao
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Jung-Im Shin
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Teresa K. Chen
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University Department of Internal Medicine, Division of Nephrology, Baltimore, Maryland
| | - Yingying Sang
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Josef Coresh
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Alex R. Chang
- Division of Nephrology, Geisinger Health System, Danville, Pennsylvania
| | - Morgan E. Grams
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University Department of Internal Medicine, Division of Nephrology, Baltimore, Maryland
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Anderson SD, Tabassum A, Yeon JK, Sharma G, Santos P, Soong TH, Thu YW, Nies I, Kurita T, Chandler A, Alsamarah A, Kanassatega RS, Luo YL, Botello-Smith WM, Andresen BT. In silico prediction of ARB resistance: A first step in creating personalized ARB therapy. PLoS Comput Biol 2020; 16:e1007719. [PMID: 33237899 PMCID: PMC7725353 DOI: 10.1371/journal.pcbi.1007719] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 12/09/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022] Open
Abstract
Angiotensin II type 1 receptor (AT1R) blockers (ARBs) are among the most prescribed drugs. However, ARB effectiveness varies widely, which may be due to non-synonymous single nucleotide polymorphisms (nsSNPs) within the AT1R gene. The AT1R coding sequence contains over 100 nsSNPs; therefore, this study embarked on determining which nsSNPs may abrogate the binding of selective ARBs. The crystal structure of olmesartan-bound human AT1R (PDB:4ZUD) served as a template to create an inactive apo-AT1R via molecular dynamics simulation (n = 3). All simulations resulted in a water accessible ligand-binding pocket that lacked sodium ions. The model remained inactive displaying little movement in the receptor core; however, helix 8 showed considerable flexibility. A single frame representing the average stable AT1R was used as a template to dock Olmesartan via AutoDock 4.2, MOE, and AutoDock Vina to obtain predicted binding poses and mean Boltzmann weighted average affinity. The docking results did not match the known pose and affinity of Olmesartan. Thus, an optimization protocol was initiated using AutoDock 4.2 that provided more accurate poses and affinity for Olmesartan (n = 6). Atomic models of 103 of the known human AT1R polymorphisms were constructed using the molecular dynamics equilibrated apo-AT1R. Each of the eight ARBs was then docked, using ARB-optimized parameters, to each polymorphic AT1R (n = 6). Although each nsSNP has a negligible effect on the global AT1R structure, most nsSNPs drastically alter a sub-set of ARBs affinity to the AT1R. Alterations within N298 –L314 strongly effected predicted ARB affinity, which aligns with early mutagenesis studies. The current study demonstrates the potential of utilizing in silico approaches towards personalized ARB therapy. The results presented here will guide further biochemical studies and refinement of the model to increase the accuracy of the prediction of ARB resistance in order to increase overall ARB effectiveness. The term "personalized medicine" was coined at the turn of the century, but most medicines currently prescribed are based on disease categories and occasionally racial demographics, not personalized attributes. In cardiovascular medicine, the personalization of medication is minimal, despite the fact that not all patients respond equally to common cardiovascular medications. Here we chose one prominent cardiovascular drug target, the angiotensin receptor, and, using computer modeling, created preliminary models of over 100 known alterations to the angiotensin receptor to determine if the alterations changed the ability of clinically used drugs to interact with the angiotensin receptor. The strength of interaction was compared to the wild-type angiotensin receptor, generating a map predicting which alteration affected which drug(s). It is expected that in the future, sequencing of drug targets can be used to compare a patient’s result to a map similar to what is provided in this manuscript to choose the optimal medication based on the patient’s genetics. Such a process has the potential to facilitate the personalization of current medication therapy.
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Affiliation(s)
- Shane D. Anderson
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Asna Tabassum
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Jae Kyung Yeon
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Garima Sharma
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Priscilla Santos
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Tik Hang Soong
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Yin Win Thu
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Isaac Nies
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Tomomi Kurita
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Andrew Chandler
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Abdelaziz Alsamarah
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Rhye-Samuel Kanassatega
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
| | - Yun L. Luo
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
- * E-mail: (YLL); (WMB-S); (BTA)
| | - Wesley M. Botello-Smith
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
- * E-mail: (YLL); (WMB-S); (BTA)
| | - Bradley T. Andresen
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, California, United States of America
- * E-mail: (YLL); (WMB-S); (BTA)
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Nandi S, Potunuru UR, Kumari C, Nathan AA, Gopal J, Menon GI, Siddharthan R, Dixit M, Thangaraj PR. Altered kinetics of circulating progenitor cells in cardiopulmonary bypass (CPB) associated vasoplegic patients: A pilot study. PLoS One 2020; 15:e0242375. [PMID: 33211740 PMCID: PMC7676651 DOI: 10.1371/journal.pone.0242375] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/31/2020] [Indexed: 11/19/2022] Open
Abstract
Vasoplegia observed post cardiopulmonary bypass (CPB) is associated with substantial morbidity, multiple organ failure and mortality. Circulating counts of hematopoietic stem cells (HSCs) and endothelial progenitor cells (EPC) are potential markers of neo-vascularization and vascular repair. However, the significance of changes in the circulating levels of these progenitors in perioperative CPB, and their association with post-CPB vasoplegia, are currently unexplored. We enumerated HSC and EPC counts, via flow cytometry, at different time-points during CPB in 19 individuals who underwent elective cardiac surgery. These 19 individuals were categorized into two groups based on severity of post-operative vasoplegia, a clinically insignificant vasoplegic Group 1 (G1) and a clinically significant vasoplegic Group 2 (G2). Differential changes in progenitor cell counts during different stages of surgery were compared across these two groups. Machine-learning classifiers (logistic regression and gradient boosting) were employed to determine if differential changes in progenitor counts could aid the classification of individuals into these groups. Enumerating progenitor cells revealed an early and significant increase in the circulating counts of CD34+ and CD34+CD133+ hematopoietic stem cells (HSC) in G1 individuals, while these counts were attenuated in G2 individuals. Additionally, EPCs (CD34+VEGFR2+) were lower in G2 individuals compared to G1. Gradient boosting outperformed logistic regression in assessing the vasoplegia grouping based on the fold change in circulating CD 34+ levels. Our findings indicate that a lack of early response of CD34+ cells and CD34+CD133+ HSCs might serve as an early marker for development of clinically significant vasoplegia after CPB.
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Affiliation(s)
- Sanhita Nandi
- Laboratory of Vascular Biology, Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
| | - Uma Rani Potunuru
- Apollo Hospitals Educational and Research Foundation, Chennai, India
| | | | - Abel Arul Nathan
- Laboratory of Vascular Biology, Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
| | - Jayashree Gopal
- Department of Endocrinology and Diabetology, Apollo Hospitals, Chennai, India
- * E-mail: (JG); (MD); (PRT)
| | - Gautam I. Menon
- The Institute of Mathematical Sciences (HBNI), Chennai, India
- Departments of Physics and Biology, Ashoka University, Sonepat, India
| | | | - Madhulika Dixit
- Laboratory of Vascular Biology, Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- * E-mail: (JG); (MD); (PRT)
| | - Paul Ramesh Thangaraj
- Department of Cardiothoracic Surgery, Apollo Hospitals, Chennai, India
- Department of Mechanical Engineering, Indian Institute of Technology Madras, Chennai, India
- * E-mail: (JG); (MD); (PRT)
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Scurt FG, Menne JJ, Korda A, Haller H, Chatzikyrkou C. Effect of gender on transition of normo- to microalbuminuria under angiotensin receptor blocker therapy in diabetes. J Diabetes 2020; 12:856-859. [PMID: 32755046 DOI: 10.1111/1753-0407.13102] [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: 05/19/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022] Open
Abstract
Highlights In normoalbuminuric diabetic patients at low cardiovascular risk, the risk of transition from normo- to microalbuminuria is lower in women, despite the nonprotective effects of the angiotensin receptor blocker olmesartan. Additional methods of assessment of albuminuria in clinical studies (eg, measurements of albumin and creatinine excretion rate) should be implemented or the actually accepted higher urine albumin creatinine ratio (UACR) cutoff values for microalbuminuria in women reconsidered.
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Affiliation(s)
- Florian G Scurt
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Health Campus Immunology, Infectiology and Inflammation, Otto-von Guericke University, Magdeburg, Germany
| | - Jan J Menne
- Nephrology Section, Hannover Medical School, Hannover, Germany
- Clinic of Nephrology, Angiology and Rheumatology, KRH Klinikum Siloah, Hannover, Germany
| | - Alexandra Korda
- LVR-Klinikum Düsseldorf, Heinrich, Heine, University Düsseldorf, Düsseldorf, Germany
| | - Hermann Haller
- Nephrology Section, Hannover Medical School, Hannover, Germany
| | - Christos Chatzikyrkou
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Health Campus Immunology, Infectiology and Inflammation, Otto-von Guericke University, Magdeburg, Germany
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Kow CS, Hasan SS. The Potential Benefit of Telmisartan to Protect Overweight Patients with COPD from the Acquisition of COVID-19. Obesity (Silver Spring) 2020; 28:2035. [PMID: 32692903 PMCID: PMC7404622 DOI: 10.1002/oby.22976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Chia Siang Kow
- School of Postgraduate StudiesInternational Medical UniversityKuala LumpurMalaysia
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Rafiullah M. Can a Combination of AT1R Antagonist and Vitamin D Treat the Lung Complication of COVID-19? Am J Med Sci 2020; 360:338-341. [PMID: 32736832 PMCID: PMC7362851 DOI: 10.1016/j.amjms.2020.07.018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
Severe Acute Respiratory Distress Syndrome caused by a novel human coronavirus SARS-CoV-2 named COVID-19 and declared as a pandemic. This paper reviews the possibility of repurposing angiotensin type 1 receptor (AT1R) antagonists and vitamin D to treat COVID-19. ACE2 protein found on the cell membranes is the target of SARS-CoV-2 for entering into the host cells. Viral spike protein-binding with ACE2 down-regulates it. As ACE2 is known to protect the lung from injuries, SARS-CoV-2-induced ACE2 deficiency may expose patients to lung damage. AT1R antagonists and vitamin D increase the expression of ACE2 independently. Besides, vitamin D suppresses the compensatory increase in renin levels following the inhibition of the renin-angiotensin system by AT1R antagonists. Therefore, a combination of AT1R antagonists and vitamin D may offer protection against COVID-19 induced lung injury.
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Affiliation(s)
- Mohamed Rafiullah
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Offringa A, Montijn R, Singh S, Paul M, Pinto YM, Pinto-Sietsma* SJ. The mechanistic overview of SARS-CoV-2 using angiotensin-converting enzyme 2 to enter the cell for replication: possible treatment options related to the renin-angiotensin system. Eur Heart J Cardiovasc Pharmacother 2020; 6:317-325. [PMID: 32464637 PMCID: PMC7314063 DOI: 10.1093/ehjcvp/pvaa053] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023]
Abstract
The SARS-CoV-2 pandemic is a healthcare crisis caused by insufficient knowledge applicable to effectively combat the virus. Therefore, different scientific discovery strategies need to be connected, to generate a rational treatment which can be made available as rapidly as possible. This relies on a solid theoretical understanding of the mechanisms of SARS-CoV-2 infection and host responses, which is coupled to the practical experience of clinicians that are treating patients. Because SARS-CoV-2 enters the cell by binding to angiotensin-converting enzyme 2 (ACE2), targeting ACE2 to prevent such binding seems an obvious strategy to combat infection. However, ACE2 performs its functions outside the cell and was found to enter the cell only by angiotensin II type 1 receptor (AT1R)-induced endocytosis, after which ACE2 is destroyed. This means that preventing uptake of ACE2 into the cell by blocking AT1R would be a more logical approach to limit entry of SARS-CoV-2 into the cell. Since ACE2 plays an important protective role in maintaining key biological processes, treatments should not disrupt the functional capacity of ACE2, to counterbalance the negative effects of the infection. Based on known mechanisms and knowledge of the characteristics of SARS-CoV we propose the hypothesis that the immune system facilitates SARS-CoV-2 replication which disrupts immune regulatory mechanisms. The proposed mechanism by which SARS-CoV-2 causes disease immediately suggests a possible treatment, since the AT1R is a key player in this whole process. AT1R antagonists appear to be the ideal candidate for the treatment of SARS-CoV-2 infection. AT1R antagonists counterbalance the negative consequences of angiotesnin II and, in addition, they might even be involved in preventing the cellular uptake of the virus without interfering with ACE2 function. AT1R antagonists are widely available, cheap, and safe. Therefore, we propose to consider using AT1R antagonists in the treatment of SARS-CoV-2.
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Affiliation(s)
- Annette Offringa
- Microbiology and System Biology, Netherlands Organisation for Applied Scientific Research, The Hague, The Netherlands
| | - Roy Montijn
- Microbiology and System Biology, Netherlands Organisation for Applied Scientific Research, The Hague, The Netherlands
| | - Sandeep Singh
- Vascular Medicine, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Martin Paul
- Faculty of Health Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Yigal M Pinto
- Cardiology, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Sara-Joan Pinto-Sietsma*
- Vascular Medicine, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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Calagnan E, Gobbato M, Burba I, Del Zotto S, Toffolutti F, Serraino D, Tonutti G. COVID-19 infections in the Friuli Venezia Giulia Region (Northern Italy): a population-based retrospective analysis. Epidemiol Prev 2020; 44:323-329. [PMID: 33412825 DOI: 10.19191/ep20.5-6.s2.133] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES to study the cumulative incidence, the demographics and health conditions of the population tested for COVID-19, and to map the evolving distribution of individual cases in the population of the Friuli Venezia Giulia Region (North-Eastern Italy). DESIGN population-based observational study based on a record linkage procedure of databases included in the electronic health information system of the Friuli Venezia Giulia Region. SETTING AND PARTICIPANTS the study group consisted of individuals who resided in the Friuli Venezia Giulia Region and who underwent COVID-19 testing from 01.03 to 24.04.2020. The study group was identified from the laboratory database, which contains all the microbiological testing performed in regional facilities. Tested people were categorized into positive or negative cases, based on test results. MAIN OUTCOME MEASURES probability of being tested for and cumulative incidence of COVID-19. RESULTS the cumulative probability of being tested for COVID-19 was 278/10,000 inhabitants, while the cumulative incidence was 22 cases/10,000. Out of 33,853 tested people, 2,744 (8.1%) turned out to be positive for COVID-19. Women were tested more often than men (337 vs 216/10,000), and they showed a higher incidence of infection than men (25 and 19 infected cases/10,000 residents, respectively). Both cumulative incidence and cumulative probability of being tested were higher in the elderly population. About 25% of infected people was hosted in retirement homes and 9% was represented by healthcare workers. Thirty seven percent of positive cases had hypertension, 15% cardiologic diseases, while diabetes and cancer characterized 11.7% and 10% of the infected population, respectively. The geographic distribution of positive cases showed a faster spread of the infection in the city of Trieste, an urban area with the highest regional population density. CONCLUSIONS the COVID-19 pandemic did not hit the Friuli Venezia Giulia Region as hard as other Northern Italian Regions. In the early phase, as documented in this study, the COVID-19 pandemic particularly affected women and elderly people, especially those living in retirement homes in Trieste.
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Affiliation(s)
- Elena Calagnan
- Azienda regionale di coordinamento per la salute (ARCS), Udine (Italy);
| | - Michele Gobbato
- Azienda regionale di coordinamento per la salute (ARCS), Udine (Italy)
| | - Ivana Burba
- Azienda regionale di coordinamento per la salute (ARCS), Udine (Italy)
| | | | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di riferimento oncologico di Aviano (CRO) IRCCS Aviano (Italy)
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di riferimento oncologico di Aviano (CRO) IRCCS Aviano (Italy)
| | - Giuseppe Tonutti
- Azienda regionale di coordinamento per la salute (ARCS), Udine (Italy)
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Wu J, Du X, Lv Q, Li Z, Zheng Z, Xia Y, Tang C, Yao Z, Zhang J, Long M, Hisada M, Wu J, Zhou W, Ma C. A phase 3 double-blind randomized (CONSORT-compliant) study of azilsartan medoxomil compared to valsartan in Chinese patients with essential hypertension. Medicine (Baltimore) 2020; 99:e21465. [PMID: 32769878 PMCID: PMC7505320 DOI: 10.1097/md.0000000000021465] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Azilsartan medoxomil (AZL-M), an angiotensin II receptor blocker, has a well-characterized efficacy and safety profile in patients with hypertension. AZL-M is approved for use in over 40 countries globally; however, it is not yet approved in China. Therefore, a phase 3 registration study to assess the efficacy (antihypertensive effect), safety, and tolerability of AZL-M compared with valsartan in Chinese patients with essential hypertension was undertaken. METHODS This multicenter, double-blind, randomized, 8-week phase 3 study compared AZL-M with valsartan in Chinese patients aged ≥18 years with essential hypertension. Endpoints included change from baseline to week 8 in trough sitting clinic systolic blood pressure (scSBP) and ambulatory blood pressure monitoring parameters. RESULTS Overall, 612 patients (mean age, 57.1 years; 57.5% male) were randomized to AZL-M 80 mg (n = 209), AZL-M 40 mg (n = 199), or valsartan 160 mg (n = 204). Baseline mean scSBP was similar in all groups (157.9-158.5 mm Hg). The mean reduction in trough scSBP from baseline to week 8 was significantly greater with AZL-M 80 mg than with valsartan (-24.2 vs -20.6 mm Hg; P = .010), and noninferior with AZL-M 40 mg versus valsartan (-22.5 vs -20.6 mm Hg; P = .184). Mean reduction in 24-hour mean systolic blood pressure (n = 257) was significantly greater with both AZL-M 80 mg (-17.0 mm Hg; P < .001) and AZL-M 40 mg (-14.7 mm Hg; P = .014) than with valsartan (-9.4 mm Hg). Treatment-emergent adverse events had similar incidence (52.8%-56.5%) across the treatment groups and were generally mild or moderate. Dizziness was the most frequent treatment-related treatment-emergent adverse events (AZL-M 80 mg, 1.9%; AZL-M 40 mg, 1.5%; valsartan, 1.0%). The safety and tolerability of AZL-M were comparable with valsartan. CONCLUSIONS AZL-M was noninferior to valsartan at the 40-mg dose and superior to valsartan at the 80-mg dose in reducing trough scSBP, and showed acceptable safety-consistent with the AZL-M safety profile in other populations-in Chinese adults with hypertension. TRIAL REGISTRATION NUMBER NCT02480764.
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Affiliation(s)
- Jiahui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Beijing
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Beijing
| | - Zhanquan Li
- Department of Cardiology, People's Hospital of Liaoning Province, Liaoning
| | - Zeqi Zheng
- Department of Cardiology, the First Affiliated Hospital of NanChang University, Jiangxi
| | - Yong Xia
- Department of Cardiology, the Affiliated Hospital of Xuzhou Medical College
| | - Chengchun Tang
- Department of Cardiology, Southeast University, Zhongda Hospital, Jiangsu
| | - Zhuhua Yao
- Department of Cardiology, Tianjin People's Hospital, Tianjin
| | - Jun Zhang
- Department of Cardiology, Hebei Cangzhou Central Hospital, Hebei
| | - Mingzhi Long
- Department of Cardiology, Nanjing Medical University Affiliated 2nd Hospital, Jiangsu, China
| | - Michie Hisada
- Global Patient Safety Evaluation, Takeda Development Center Americas, Inc., Deerfield, IL
| | - Jingtao Wu
- Statistics and Quantitative Sciences, Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Wei Zhou
- Clinical Science, Takeda Development Center Asia, Pte. Ltd., Shanghai, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Beijing
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Zhang G, Fan Y, Qiu Y, Zhou Z, Zhang J, Wang Z, Liu Y, Liu X, Tao J. Allisartan Isoproxil Improves Endothelial Function and Vascular Damage in Patients with Essential Hypertension: A Single-Center, Open-Label, Randomized Controlled Trial. Adv Ther 2020; 37:3551-3561. [PMID: 32583313 DOI: 10.1007/s12325-020-01413-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Allisartan isoproxil is a novel angiotensin II type 1 receptor antagonist that has been confirmed to lower blood pressure and protect target organs effectively. However, its role in improving endothelial function and vascular damage has not been investigated yet. METHODS Patients with initially diagnosed mild essential hypertension (BP ranging from 140/90 to 159/99 mmHg) with age from 25-75 years were randomly assigned 1:1 to either the allisartan group (allisartan 240 mg/day and lifestyle modification) or the lifestyle modification group and were followed up for 30 days. Flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and endothelial microparticles (EMPs) were measured for evaluation of endothelial function and vascular damage. In addition, we enrolled 36 normotensive individuals as healthy control. RESULTS Seventy-two mildly hypertensive patients were enrolled in this study. After 30 days of treatment, a significant increase in FMD was observed in the allisartan group (0.9 ± 0.7%, p < 0.001) and remained unchanged in the lifestyle modification group, but the difference between the two groups did not reach statistical significance (p = ns). EMPs, baPWV, SBP and DBP decreased by 251.0 ± 255.9 counts/μl (p < 0.001), 102.8 ± 84.2 cm/s (p < 0.001), 13.20 ± 3.9 mmHg (p < 0.001) and 9.35 ± 2.5 mmHg (p < 0.001), respectively, in the allisartan group, while by 21.3 ± 84.3 counts/μl (p = ns), 0.4 ± 22.0 cm/s (p = ns), 3.2 ± 6.0 mmHg (p < 0.01) and 1.0 ± 2.5 mmHg (p = ns), respectively, in the lifestyle modification group. All of the indexes above achieved statistical significance between the allisartan and lifestyle modification groups (p < 0.05). Besides, after 30 days of allisartan administration baPWV and EMPs were comparable to those measured in the healthy control group, while the difference in SBP, DBP and FMD remained significant between the allisartan and healthy control groups (p < 0.05). CONCLUSION The present study demonstrates for the first time that allisartan isoproxil exerts a favorable effect on improving endothelial function and vascular damage in patients with mild EH, making it a promising drug for management of EH. CLINICAL TRIAL REGISTRATION ChiCTR2000032332.
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Affiliation(s)
- Gaoxing Zhang
- Department of Cardiology, The Jiangmen Central Hospital, Jiangmen, China
| | - Yongqiang Fan
- Department of Cardiology, The Jiangmen Central Hospital, Jiangmen, China
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yumin Qiu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhe Zhou
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jianning Zhang
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhichao Wang
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuanya Liu
- Department of Cardiology, The Jiangmen Central Hospital, Jiangmen, China
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xing Liu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Nitulescu GM, Paunescu H, Moschos SA, Petrakis D, Nitulescu G, Ion GND, Spandidos DA, Nikolouzakis TK, Drakoulis N, Tsatsakis A. Comprehensive analysis of drugs to treat SARS‑CoV‑2 infection: Mechanistic insights into current COVID‑19 therapies (Review). Int J Mol Med 2020; 46:467-488. [PMID: 32468014 PMCID: PMC7307820 DOI: 10.3892/ijmm.2020.4608] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022] Open
Abstract
The major impact produced by the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) focused many researchers attention to find treatments that can suppress transmission or ameliorate the disease. Despite the very fast and large flow of scientific data on possible treatment solutions, none have yet demonstrated unequivocal clinical utility against coronavirus disease 2019 (COVID‑19). This work represents an exhaustive and critical review of all available data on potential treatments for COVID‑19, highlighting their mechanistic characteristics and the strategy development rationale. Drug repurposing, also known as drug repositioning, and target based methods are the most used strategies to advance therapeutic solutions into clinical practice. Current in silico, in vitro and in vivo evidence regarding proposed treatments are summarized providing strong support for future research efforts.
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Affiliation(s)
| | - Horia Paunescu
- Faculty of Medicine, ′Carol Davila′ University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Sterghios A. Moschos
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University
- PulmoBioMed Ltd., Newcastle-Upon-Tyne NE1 8ST, UK
| | | | | | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
| | | | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
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Cunningham JW, Vaduganathan M, Claggett BL, John JE, Desai AS, Lewis EF, Zile MR, Carson P, Jhund PS, Kober L, Pitt B, Shah SJ, Swedberg K, Anand IS, Yusuf S, McMurray JJV, Pfeffer MA, Solomon SD. Myocardial Infarction in Heart Failure With Preserved Ejection Fraction: Pooled Analysis of 3 Clinical Trials. JACC Heart Fail 2020; 8:618-626. [PMID: 32387067 DOI: 10.1016/j.jchf.2020.02.007] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/06/2020] [Accepted: 02/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The authors investigated the relationship between past or incident myocardial infarction (MI) and cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF). BACKGROUND MI and HFpEF share some common risk factors. The prognostic significance of MI in patients with HFpEF is uncertain. METHODS The authors pooled data from 3 trials-CHARM Preserved (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity), I-Preserve (Irbesartan in Heart Failure With Preserved Systolic Function), and the Americas region of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) (N = 8,916)-and examined whether MI before or following enrollment independently predicted CV death and heart failure (HF) hospitalization. RESULTS At baseline, 2,668 patients (30%) had history of MI. Prior MI was independently associated with greater risk of CV death (4.7 vs. 3.5 events/100 patient-years [py], adjusted hazard ratio [HR]: 1.42 [95% confidence interval (CI): 1.23 to 1.64]; p < 0.001). Excess sudden death drove this difference (1.9 vs. 1.2 events/100 py, adjusted HR: 1.55 [95% CI: 1.23 to 1.97]; p < 0.001). There was no difference in HF hospitalization (5.9 vs. 5.5 events/100 py, adjusted HR: 1.05, 95% CI: 0.92 to 1.19) or HF death by prior MI. During follow-up, MI occurred in 336 patients (3.8%). Risk of CV death increased 31-fold in the first 30 days after first post-enrollment MI, and remained 58% higher beyond 1 year after MI. Risk of first or recurrent HF hospitalization increased 2.4-fold after MI. CONCLUSIONS Prior MI in HFpEF is associated with greater CV and sudden death but similar risk of HF outcomes. Patients with HFpEF who experience MI are at high risk of subsequent CV death and HF hospitalization. These data highlight the importance of primary and secondary prevention of MI in patients with HFpEF. (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712; Irbesartan in Heart Failure With Preserved Systolic Function [I-Preserve]; NCT00095238; and Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT]; NCT00094302).
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Affiliation(s)
| | | | | | | | | | | | - Michael R Zile
- RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, South Carolina
| | | | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Lars Kober
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Inder S Anand
- VA Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - Salim Yusuf
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
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Hu YY, Fang QQ, Wang XF, Zhao WY, Zheng B, Zhang DD, Tan WQ. Angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor blocker: Potential agents to reduce post-surgical scar formation in humans. Basic Clin Pharmacol Toxicol 2020; 127:488-494. [PMID: 32564469 DOI: 10.1111/bcpt.13458] [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: 05/01/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022]
Abstract
Studies on the effectiveness and mechanisms of reducing scar formation by interfering with the renin-angiotensin-aldosterone-system (RAAS) have been demonstrated in animals, but not in humans due to the lack of clinical support. Our aim was to investigate whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II type 1 receptor blocker (ARB) could inhibit scar formation in humans. Thus, an observational and hypothesis-generating study using a designed questionnaire was carried out. A total of 347 patients with postoperative scars secondary to thyroid tumours were enrolled. They were divided into four groups: ACEI group, ARB group, other antihypertensive drugs control group and blank control group according to the administration of antihypertensive drugs. The width of scar was measured, and the Scar Cosmesis Assessment and Rating (SCAR) Scale was filled out. Results showed that patients of ACEI group (mean scar width 1.60 mm) and ARB group (mean scar width 1.57 mm) formed smaller scars than those of other antihypertensive drugs control group (mean scar width 2.09 mm) and blank control group (mean scar width 2.0 mm). Oral administration of ACEI and ARB may be associated with better post-surgical scar formation in humans. These two kinds of antihypertensive drugs may be active components of anti-scar medicine.
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Affiliation(s)
- Yan-Yan Hu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Qing Fang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Feng Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wan-Yi Zhao
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Zheng
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ding-Ding Zhang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhou H, Fang Y, Xu T, Ni W, Shen A, Meng X. Potential therapeutic targets and promising drugs for combating SARS-CoV-2. Br J Pharmacol 2020; 177:3147-3161. [PMID: 32368792 PMCID: PMC7267399 DOI: 10.1111/bph.15092] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
As of April 9, 2020, a novel coronavirus (SARS-CoV-2) had caused 89,931 deaths and 1,503,900 confirmed cases worldwide, which indicates an increasingly severe and uncontrollable situation. Initially, little was known about the virus. As research continues, we now know the genome structure, epidemiological and clinical characteristics, and pathogenic mechanisms of SARS-CoV-2. Based on this knowledge, potential targets involved in the processes of virus pathogenesis need to be identified, and the discovery or development of drugs based on these potential targets is the most pressing need. Here, we have summarized the potential therapeutic targets involved in virus pathogenesis and discuss the advances, possibilities, and significance of drugs based on these targets for treating SARS-CoV-2. This review will facilitate the identification of potential targets and provide clues for drug development that can be translated into clinical applications for combating SARS-CoV-2.
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Affiliation(s)
- Hong Zhou
- Department of Pharmacy, Anhui Provincial Cancer Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Yan Fang
- Department of Pharmacy, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Tao Xu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of PharmacyAnhui Medical UniversityHefeiChina
| | - Wei‐Jian Ni
- Department of Pharmacy, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of PharmacyAnhui Medical UniversityHefeiChina
| | - Ai‐Zong Shen
- Department of Pharmacy, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Xiao‐Ming Meng
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of PharmacyAnhui Medical UniversityHefeiChina
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Hegazy N, Rezq S, Fahmy A. Mechanisms Involved in Superiority of Angiotensin Receptor Blockade over ACE Inhibition in Attenuating Neuropathic Pain Induced in Rats. Neurotherapeutics 2020; 17:1031-1047. [PMID: 32804335 PMCID: PMC7609714 DOI: 10.1007/s13311-020-00912-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 12/14/2022] Open
Abstract
Although previous reports described the beneficial role of angiotensin-converting enzyme inhibitors (ACE-Is) or AT1 receptor blockers (ARBs) in attenuating neuropathic pain (NP), no study has yet explored the exact underlying mechanisms, as well as the superiority of using centrally versus peripherally acting renin-angiotensin-aldosterone system (RAAS) drugs in NP. We investigated the effects of 14 days of treatment with centrally (telmisartan and ramipril) or peripherally (losartan and enalapril) acting ARBs and ACE-Is, respectively, in attenuating peripheral NP induced by sciatic nerve chronic constriction injury (CCI) in rats. We also compared these with the effects of pregabalin, the standard treatment for NP. Behavioral changes, inflammatory markers (NFкB, TNF-α, COX-2, PGE2, and bradykinin), oxidative stress markers (NADPH oxidase and catalase), STAT3 activation, levels of phosphorylated P38-MAPK, ACE, AT1 receptor (AT1R), and AT2 receptor (AT2R), as well as histopathological features, were assessed in the brainstem and sciatic nerve. CCI resulted in clear pain-related behavior along with increased levels of inflammatory and oxidative stress markers, and STAT3 activity, as well as increased levels of phosphorylated P38-MAPK, ACE, AT1R, and AT2R, along with worsened histopathological findings in both the brainstem and sciatic nerve. ARBs improved both animal behavior and all measured parameters in CCI rats and were more effective than ACE-Is. At the tested doses, centrally acting ARBs or ACE-Is were not superior to the peripherally acting drugs of the same category. These findings suggest that ARBs (centrally or peripherally acting) are an effective treatment modality for NP.
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Affiliation(s)
- Nora Hegazy
- Department of Pharmacology and Toxicology, School of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Samar Rezq
- Department of Pharmacology and Toxicology, School of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 North State Street, Jackson, 39216, MS, USA.
| | - Ahmed Fahmy
- Department of Pharmacology and Toxicology, School of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
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