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Bernardi S, Tonon F, Barbieri M, Zamagni G, Nuredini R, Perer L, Comar S, Toffoli B, Ronfani L, Ricci G, Fabris B, Stampalija T. A longitudinal study on the effect of obesity upon circulating renin-angiotensin system in normal pregnancy. Nutr Metab Cardiovasc Dis 2024; 34:771-782. [PMID: 38161127 DOI: 10.1016/j.numecd.2023.10.030] [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: 04/04/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIMS Obesity is the most common health issue in women of reproductive age, which profoundly affects maternal-fetal health. Despite progress in understanding key inflammatory and metabolic changes, the pathogenesis of the cardiovascular phenotype of obese pregnant women remains to be fully understood. This study aimed at: (i) evaluating the changes of the renin-angiotensin system (RAS) throughout pregnancy in obese vs normal weight (control) women, and (ii) evaluating the presence of any associations between maternal hemodynamic status and RAS changes. METHODS AND RESULTS Thirty-eight normal weight and nineteen obese pregnant women were included. Clinical assessment, blood samples and maternal hemodynamic evaluation were performed at 12, 20, 30, and 36 weeks, while ultrasound assessment was scheduled at 20, 30, and 36 weeks of gestation. Measurements of sFlt-1, PlGF, Angiotensinogen, Renin, AngII, Ang1-7, ACE and ACE2 were performed by ELISA. Our data show that normotensive obese women had lower placental blood supply, as assessed by UV-Q and UV-Q/EFW, as compared to controls, and significantly higher levels of AngII and AngII/Ang1-7 ratio, which were inversely related to placental blood supply. CONCLUSIONS Our study shows for the first time that normotensive obese women exhibited a significant progressive increase of AngII and AngII/Ang1-7 throughout pregnancy, which were inversely related to placental blood supply as assessed by UV-Q and UV-Q/EFW. Our data shed light on the early changes in pregnant obese women and suggest that RAS dysregulation is a prerequisite rather than a consequence of hypertensive disorders of pregnancy and other maternal neonatal complications.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy; Unit of Endocrinology, ASUGI, Cattinara Teaching Hospital, 34149, Trieste, Italy.
| | - Federica Tonon
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - Moira Barbieri
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34147, Trieste, Italy
| | - Roberto Nuredini
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - Laura Perer
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - Sarah Comar
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - Barbara Toffoli
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34147, Trieste, Italy
| | - Giuseppe Ricci
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy; Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy; Unit of Endocrinology, ASUGI, Cattinara Teaching Hospital, 34149, Trieste, Italy
| | - Tamara Stampalija
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy; Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137, Trieste, Italy
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Dowell J, Bice Z, Yan K, Konduri GG. Hyperoxia-induced airflow restriction and Renin-Angiotensin System expression in a bronchopulmonary dysplasia mouse model. Physiol Rep 2024; 12:e15895. [PMID: 38163662 PMCID: PMC10758334 DOI: 10.14814/phy2.15895] [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: 08/04/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Mechanisms underlying hyperoxia-induced airflow restriction in the pediatric lung disease Bronchopulmonary dysplasia (BPD) are unclear. We hypothesized a role for Renin-Angiotensin System (RAS) activity in BPD. RAS is comprised of a pro-developmental pathway consisting of angiotensin converting enzyme-2 (ACE2) and angiotensin II receptor type 2 (AT2), and a pro-fibrotic pathway mediated by angiotensin II receptor type 1 (AT1). We investigated associations between neonatal hyperoxia, airflow restriction, and RAS activity in a BPD mouse model. C57 mouse pups were randomized to normoxic (FiO2 = 0.21) or hyperoxic (FiO2 = 0.75) conditions for 15 days (P1-P15). At P15, P20, and P30, we measured airflow restriction using plethysmography and ACE2, AT1, and AT2 mRNA and protein expression via polymerase chain reaction and Western Blot. Hyperoxia increased airflow restriction P15 and P20, decreased ACE2 and AT2 mRNA, decreased AT2 protein, and increased AT1 protein expression. ACE2 mRNA and protein remained suppressed at P20. By P30, airflow restriction and RAS expression did not differ between groups. Hyperoxia caused high airflow restriction, increased pulmonary expression of the pro-fibrotic RAS pathway, and decreased expression of the pro-developmental in our BPD mouse model. These associated findings may point to a causal role for RAS in hyperoxia-induced airflow restriction.
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Affiliation(s)
| | - Zachary Bice
- Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Ke Yan
- Medical College of WisconsinMilwaukeeWisconsinUSA
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Khodadadiyan A, Rahmanian M, Shekouh D, Golmohammadi M, Ghaedi A, Bazrgar A, Sayadi M, Bazrafshan M, Heydari A, Bazrafshan Drissi H. Evaluating the effect of vitamin D supplementation on serum levels of 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, parathyroid hormone and renin-angiotensin-aldosterone system: a systematic review and meta-analysis of clinical trials. BMC Nutr 2023; 9:132. [PMID: 37968749 PMCID: PMC10652523 DOI: 10.1186/s40795-023-00786-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Vitamin D, one of the most essential micronutrients, is crucial in various health outcomes. However, previous studies showed conflicting results and uncertainty about vitamin D supplementation's optimal dosage and duration. In this study, we aimed to evaluate the vitamin D supplements efficiency on serum levels of 25-hydroxy vitamin D (25(OH)D), 1,25-dihdroxy vitamin D (1,25(OH)2D), parathyroid hormone (PTH) and renin-angiotensin-aldosterone system (RAAS) in adults. METHODS A systematic analysis of eligible and relevant randomized-controlled trials (RCT) published before April 2023 assessing the effect of vitamin D supplementations applied. The studies were identified by searching several databases, including Pubmed, Scopus, Web of Science, ProQuest, and Cochrane Register of controlled trials. RESULTS Five eligible RCTs with 346 participants in the intervention and 352 participants in the control group were assessed in our project. According to the results, there was a substantial change in 25(OH)D (SMD: 2.2, I2: 92.3, 95% Confidence Interval (CI): 1.38-3.02, P-value: 0.048) and 1,25(OH)2D (SMD:1.23, I2: 86.3, 95% CI: 0.01- 2.44, P-value < 0.010) affected by vitamin D intervention. Regarding Parathyroid hormone (PTH), however, vitamin D intervention showed a remarkable decrease (SMD: -0.75, I2: 82.4, 95% CI: (-1.3)-(-0.18), P-value < 0.010). Moreover, sensitivity analysis showed significant publication bias in terms of 25(OH)D. CONCLUSION Vitamin D supplements significantly increase the serum levels of 25(OH)D and 1,25(OH)2D and decrease PTH levels. While some studies reported decreasing effect of vitamin D supplements on RAAS activity, some reported no changes.
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Affiliation(s)
- Alireza Khodadadiyan
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Dorsa Shekouh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Melika Golmohammadi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Aigin Heydari
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
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Mulas O, Mola B, Costa A, Pittau F, Mantovani D, Dessì S, Fronteddu A, La Nasa G, Caocci G. Renin-angiotensin inhibitors reduce thrombotic complications in Essential Thrombocythemia and Polycythemia Vera patients with arterial hypertension. Ann Hematol 2023; 102:2717-2723. [PMID: 37603060 PMCID: PMC10492873 DOI: 10.1007/s00277-023-05417-w] [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: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
Essential Thrombocythemia (ET) and Polycythemia Vera (PV) are chronic myeloproliferative neoplasms (MPNs) characterized by thrombotic and hemorrhagic complications, leading to a high risk of disability and mortality. Although arterial hypertension was found to be the most significant modifiable cardiovascular (CV) risk factor in the general population, little is known about its role in MPNs as well as a possible role of renin-angiotensin system inhibitors (RASi) in comparison with other anti-hypertensive treatments. We investigated a large cohort of 404 MPN adult patients, 133 diagnosed with PV and 271 with ET. Over half of the patients (53.7%) reported hypertension at MPN diagnosis. The 15-year cumulative incidence of thrombotic-adverse events (TAEs) was significantly higher in patients with hypertension (66.8 ± 10.3% vs 38.5 ± 8.4%; HR = 1.83; 95%CI 1.08-3.1). Multivariate analysis showed that PV diagnosis and hypertension were independently associated with a higher risk of developing TAEs (HR = 3.5; 95%CI 1.928-6.451, p < 0.001 and HR = 1.8; 95%CI 0.983-3.550, p = 0.05, respectively). In multivariate analysis, the diagnosis of PV confirmed a significant predictive role in developing TAEs (HR = 4.4; 95%CI 1.92-10.09, p < 0.01), also considering only MPN patients with hypertension. In addition, we found that the use of RASi showed a protective effect from TAEs both in the whole cohort of MPN with hypertension (HR = 0.46; 95%CI 0.21-0.98, p = 0.04) and in the subgroup of thrombotic high-risk score patients (HR = 0.49; 95%CI 0.24-1.01, p = 0.04). In particular, patients with ET and a high risk of thrombosis seem to benefit most from RASi treatment (HR = 0.27; 95%CI 0.07-1.01, p = 0.03). Hypertension in MPN patients represents a significant risk factor for TAEs and should be adequately treated.
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Affiliation(s)
- Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Brunella Mola
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandro Costa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Pittau
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Mantovani
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Samuele Dessì
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonella Fronteddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy.
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Hwang HJ, Han SA. Differential Cardiovascular Outcomes of Each Antihypertensive Drug Class in Patients With Hypertension and Breast Cancer Undergoing Doxorubicin-Containing Chemotherapy. J Breast Cancer 2023; 26:492-503. [PMID: 37704380 PMCID: PMC10625866 DOI: 10.4048/jbc.2023.26.e34] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE The preemptive use of renin-angiotensin system (RAS) inhibitors may reduce doxorubicin (DOX)-related cardiotoxicity. Using the national insurance claims data of Korea, this study compared cardiovascular (CV) outcomes following the use of four major antihypertensive drug classes in patients with hypertension and breast cancer who underwent DOX-containing chemotherapy. METHODS A total of 4,722 patients with hypertension and breast cancer who underwent DOX-containing chemotherapy were included. The outcomes were compared between patients who used RAS inhibitors, calcium channel blockers (CCBs), beta-blockers (BBs), and thiazide and thiazide-like diuretics (TDs). The primary outcome was a composite of incident heart failure and serious ventricular arrhythmias, including ventricular tachycardia and fibrillation, ischemic heart disease, and stroke. RESULTS In the propensity score-matched population, there were no significant differences in the primary outcome between RAS inhibitor and CCB users; however, patients with diabetes who used CCBs had a worse primary outcome than those who used RAS inhibitors (adjusted hazard ratio [aHR], 1.93; 95% confidence interval [CI], 1.06-3.51). BB and TD users had a worse primary outcome compared with RAS inhibitor (aHR, 1.88; 95% CI, 1.30-2.71 in BB users and aHR, 2.55; 95% CI, 1.37-4.75 in TD users) or CCB (aHR, 1.54; 95% CI, 1.09-2.16 in BB users and aHR, 2.08; 95% CI, 1.13-3.82 in TD users) users. CONCLUSION RAS inhibitors are preferred for the treating hypertension and improving CV outcomes in patients with hypertension and breast cancer undergoing DOX-containing chemotherapy, particularly in patients with comorbid diabetes. However, CCBs are equivalent to RAS inhibitors and are more favorable than BBs and TDs in terms of improving CV outcomes.
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Affiliation(s)
- Hui-Jeong Hwang
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang-Ah Han
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
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Silva-Velasco DL, Beltran-Ornelas JH, Tapia-Martínez J, Sánchez-López A, de la Cruz SH, Cervantes-Pérez LG, Del Valle-Mondragón L, Sánchez-Mendoza A, Centurión D. NaHS restores the vascular alterations in the renin-angiotensin system induced by hyperglycemia in rats. Peptides 2023; 164:171001. [PMID: 36990388 DOI: 10.1016/j.peptides.2023.171001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
Hyperglycemia (HG) impairs the renin-angiotensin system (RAS), which may contribute to vascular dysfunction. Besides, hydrogen sulfide (H2S) exerts beneficial cardiovascular effects in metabolic diseases. Therefore, our study aimed to determine the effects of chronic administration of sodium hydrosulfide (NaHS; inorganic H2S donor) and DL-Propargylglycine [DL-PAG; cystathionine-ץ-lyase (CSE) inhibitor] on the RAS-mediated vascular responses impairments observed in thoracic aortas from male diabetic Wistar rats. For that purpose, neonatal rats were divided into two groups that received: 1) citrate buffer (n = 12) or 2) streptozotocin (STZ, 70 mg/kg; n = 48) on the third postnatal day. After 12 weeks, diabetic animals were divided into 4 subgroups (n = 12 each) that received daily i.p. injections during 4 weeks of: 1) non-treatment; 2) vehicle (PBS, 1 mL/kg); 3) NaHS (5.6 mg/kg); and 4) DL-PAG (10 mg/kg). After treatments (16 weeks), blood glucose, angiotensin-(1-7) [Ang-(1-7)], and angiotensin II (Ang II) levels, vascular responses to Ang-(1-7) and Ang II, and the expression of angiotensin AT1, AT2, and Mas receptors, angiotensin converting enzyme (ACE) and ACE type 2 (ACE2) were determined. HG induced: 1) increased blood glucose levels and expression of angiotensin II AT1 receptor; 2) impaired Ang-(1-7) and Ang II mediated vascular responses; 3) decreased angiotensin levels and expression of angiotensin II AT2 and angiotensin-(1-7) Mas receptors, and ACE2; and 4) no changes in ACE expression. Interestingly, NaHS, but not DL-PAG, reversed HG-induced impairments, except for blood glucose level changes. These results suggest that NaHS restores vascular function in streptozotocin-induced HG through RAS modulation.
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Affiliation(s)
- Diana L Silva-Velasco
- Departamento de Farmacobiología, Cinvestav-Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Alcaldía Tlalpan C.P. 14330, Mexico
| | - Jesus H Beltran-Ornelas
- Departamento de Farmacobiología, Cinvestav-Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Alcaldía Tlalpan C.P. 14330, Mexico
| | - Jorge Tapia-Martínez
- Departamento de Farmacobiología, Cinvestav-Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Alcaldía Tlalpan C.P. 14330, Mexico
| | - Araceli Sánchez-López
- Departamento de Farmacobiología, Cinvestav-Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Alcaldía Tlalpan C.P. 14330, Mexico
| | - Saúl Huerta de la Cruz
- Departamento de Farmacobiología, Cinvestav-Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Alcaldía Tlalpan C.P. 14330, Mexico
| | - Luz Graciela Cervantes-Pérez
- Departamento de Farmacología, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No.1, Col. Sección XVI, Alcaldía Tlalpan C.P. 14080, Mexico
| | - Leonardo Del Valle-Mondragón
- Departamento de Farmacología, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No.1, Col. Sección XVI, Alcaldía Tlalpan C.P. 14080, Mexico
| | - Alicia Sánchez-Mendoza
- Departamento de Farmacología, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No.1, Col. Sección XVI, Alcaldía Tlalpan C.P. 14080, Mexico.
| | - David Centurión
- Departamento de Farmacobiología, Cinvestav-Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Alcaldía Tlalpan C.P. 14330, Mexico.
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Guimarães VHD, Marinho BM, Motta-Santos D, Mendes GDRL, Santos SHS. Nutritional implications in the mechanistic link between the intestinal microbiome, renin-angiotensin system, and the development of obesity and metabolic syndrome. J Nutr Biochem 2023; 113:109252. [PMID: 36509338 DOI: 10.1016/j.jnutbio.2022.109252] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/12/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Obesity and metabolic disorders represent a significant global health problem and the gut microbiota plays an important role in modulating systemic homeostasis. Recent evidence shows that microbiota and its signaling pathways may affect the whole metabolism and the Renin-Angiotensin System (RAS), which in turn seems to modify microbiota. The present review aimed to investigate nutritional implications in the mechanistic link between the intestinal microbiome, renin-angiotensin system, and the development of obesity and metabolic syndrome components. A description of metabolic changes was obtained based on relevant scientific literature. The molecular and physiological mechanisms that impact the human microbiome were addressed, including the gut microbiota associated with obesity, diabetes, and hepatic steatosis. The RAS interaction signaling and modulation were analyzed. Strategies including the use of prebiotics, symbiotics, probiotics, and biotechnology may affect the gut microbiota and its impact on human health.
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Affiliation(s)
- Victor Hugo Dantas Guimarães
- Laboratory of Health Science, Postgraduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Barbhara Mota Marinho
- Laboratory of Health Science, Postgraduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Daisy Motta-Santos
- School of Physical Education, Physiotherapy, and Occupational Therapy - EEFFTO, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Gabriela da Rocha Lemos Mendes
- Food Engineering, Institute of Agricultural Sciences (ICA), Universidade Federal de Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil
| | - Sérgio Henrique Sousa Santos
- Laboratory of Health Science, Postgraduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil; Food Engineering, Institute of Agricultural Sciences (ICA), Universidade Federal de Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil.
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Pontes CNR, Scalzo S, Jesus ICG, Jesus EFD, Nunes ADDC, Mendonça MM, Mendes EP, Colugnati DB, Xavier CH, Pedrino GR, Guatimosim S, Castro CH. Angiotensin-(1-7) attenuates the negative inotropic response to acetylcholine in the heart. Peptides 2022; 158:170862. [PMID: 35998722 DOI: 10.1016/j.peptides.2022.170862] [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: 06/09/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 02/09/2023]
Abstract
Previous studies have suggested that the Angiotensin-(1-7) [(Ang-(1-7)] can change cardiac function by modulating the autonomic nervous system. However, it is unknown whether the Ang-(1-7) can modulate the effect of acetylcholine (ACh) in ventricular contractility. Thus, this study aimed to investigate whether Ang-(1-7) modifies the amplitude of the cardiac cholinergic effects and if these effects are intrinsic to the heart. In anesthetized Wistar rats, Ang-(1-7) attenuated the effect of ACh in decreasing the left ventricular end-systolic pressure (LVESP), dP/dtmax, and dP/dtmin, but did not modify the hypotensive effect of ACh. Similarly, Ang-(1-7) attenuated the reduction of the LVESP, dP/dtmax, and dP/dtmin evoked by ACh in isolated hearts. These effects were blocked by the Mas receptor antagonist, A-779, but not by the adenylyl cyclase inhibitor MDL-12,330 A. Ang-(1-7) also attenuated the reduction in the maximum contraction and relaxation speeds and the shortening promoted by ACh in isolated cardiomyocytes. These data show that Ang-(1-7) acting through Mas receptor counter-regulates the myocardial contractile response to ACh in an arterial pressure and heart rate-independent manner.
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Affiliation(s)
- Carolina Nobre Ribeiro Pontes
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Sérgio Scalzo
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
| | - Itamar Couto Guedes Jesus
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
| | - Erika Fernandes de Jesus
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Allancer Divino de Carvalho Nunes
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil; Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michelle Mendanha Mendonça
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Elizabeth Pereira Mendes
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Diego Basile Colugnati
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Carlos Henrique Xavier
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Gustavo Rodrigues Pedrino
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil
| | - Silvia Guatimosim
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
| | - Carlos Henrique Castro
- Department of Physiological Sciences, Institute of Biological Sciences, Universidade Federal de Goiás, 74690-900 Goiânia, Brazil.
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Rajak P, Roy S, Podder S, Dutta M, Sarkar S, Ganguly A, Mandi M, Dutta A, Nanda S, Khatun S. Synergistic action of organophosphates and COVID-19 on inflammation, oxidative stress, and renin-angiotensin system can amplify the risk of cardiovascular maladies. Toxicol Appl Pharmacol 2022; 456:116267. [PMID: 36240863 PMCID: PMC9554205 DOI: 10.1016/j.taap.2022.116267] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022]
Abstract
Organophosphates (OPs) are ubiquitous environmental contaminants, widely used as pesticides in agricultural fields. In addition, they serve as flame-retardants, plasticizers, antifoaming or antiwear agents in lacquers, hydraulic fluids, and floor polishing agents. Therefore, world-wide and massive application of these compounds have increased the risk of unintentional exposure to non-targets including the human beings. OPs are neurotoxic agents as they inhibit the activity of acetylcholinesterase at synaptic cleft. Moreover, they can fuel cardiovascular issues in the form of myocardities, cardiac oedema, arrhythmia, systolic malfunction, infarction, and altered electrophysiology. Such pathological outcomes might increase the severity of cardiovascular diseases which are the leading cause of mortality in the developing world. Coronavirus disease-19 (COVID-19) is the ongoing global health emergency caused by SARS-CoV-2 infection. Similar to OPs, SARS-CoV-2 disrupts cytokine homeostasis, redox-balance, and angiotensin-II/AT1R axis to promote cardiovascular injuries. Therefore, during the current pandemic milieu, unintentional exposure to OPs through several environmental sources could escalate cardiac maladies in patients with COVID-19.
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Affiliation(s)
- Prem Rajak
- Department of Animal Science, Kazi Nazrul University, Asansol, West Bengal, India,Corresponding author
| | - Sumedha Roy
- Cytogenetics Laboratory, Department of Zoology, The University of Burdwan, West Bengal, India
| | | | - Moumita Dutta
- Departments of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Saurabh Sarkar
- Department of Zoology, Gushkara Mahavidyalaya; Gushkara, Purba Bardhaman, West Bengal, India
| | - Abhratanu Ganguly
- Department of Animal Science, Kazi Nazrul University, Asansol, West Bengal, India
| | - Moutushi Mandi
- Toxicology Research Unit, Department of Zoology, The University of Burdwan, Purba Bardhaman, West Bengal, India
| | - Anik Dutta
- Post Graduate Department of Zoology, Darjeeling Govt. College, West Bengal, India
| | - Sayantani Nanda
- Department of Animal Science, Kazi Nazrul University, Asansol, West Bengal, India
| | - Salma Khatun
- Department of Zoology, Krishna Chandra College, Hetampur, West Bengal, India
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10
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Wang YF, Ren XY, Zhang W, Rao GW. Research Progress in Pharmacological Mechanisms, Structure-Activity Relationship and Synthesis of Sartans. Curr Med Chem 2022; 30:2247-2266. [PMID: 36043743 DOI: 10.2174/0929867329666220829101436] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Abstract
: The sartans are a new class of antihypertensive drugs as angiotensin II receptor blockers which possess plenty of ad-vantages in treating hypertension and related pathologies. This review describes the clinical treatment, side effects, and po-tential therapeutic effects of sartans from 1995 to date. The synthesis, structural-activity and molecular docking with Angi-otensin Type 1 receptor of imidazole derivatives, benzimidazole derivatives and other compounds are also described. With clear Structure-Activity Relationship and abundant pharmacological effects, some types of novel Angiotensin Type 1 re-ceptor antagonists are emerging gradually for further research in the meantime.
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Affiliation(s)
- Ye-Fan Wang
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
| | - Xin-Yue Ren
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
| | - Wen Zhang
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
| | - Guo-Wu Rao
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
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11
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Gouveia F, Camins A, Ettcheto M, Bicker J, Falcão A, Cruz MT, Fortuna A. Targeting brain Renin-Angiotensin System for the prevention and treatment of Alzheimer's disease: Past, present and future. Ageing Res Rev 2022; 77:101612. [PMID: 35346852 DOI: 10.1016/j.arr.2022.101612] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/09/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is a well-known neurodegenerative disease characterized by the presence of two main hallmarks - Tau hyperphosphorylation and Aβ deposits. Notwithstanding, in the last few years the scientific evidence about the drivers of AD have been changing and nowadays age-related vascular alterations and several cardiovascular risk factors have been shown to trigger the development of AD. In this context, drugs targeting the Renin Angiotensin System (RAS), commonly used for the treatment of hypertension, are evidencing a high potential to delay AD development due to their action on brain RAS. Indeed, the ACE 1/Ang II/AT1R axis is believed to be upregulated in AD and to be responsible for deleterious effects such as increased oxidative stress, neuroinflammation, blood-brain barrier (BBB) hyperpermeability, astrocytes dysfunction and a decrease in cerebral blood flow. In contrast, the alternative axis - ACE 1/Ang II/AT2R; ACE 2/Ang (1-7)/MasR; Ang IV/ AT4R(IRAP) - seems to counterbalance the deleterious effects of the principal axis and to exert beneficial effects on memory and cognition. Accordingly, retrospective studies demonstrate a reduced risk of developing AD among people taking RAS medication as well as several in vitro and in vivo pre-clinical studies as it is herein critically reviewed. In this review, we first revise, at a glance, the pathophysiology of AD focused on its classic hallmarks. Secondly, an overview about the impact of the RAS on the pathophysiology of AD is also provided, focused on their four essential axes ACE 1/Ang II/AT2R; ACE 2/Ang (1-7)/MasR; Ang IV/ AT4R(IRAP) and ACE 1/Ang II/AT1R. Finally, the therapeutic potential of available drugs targeting RAS on AD, namely angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs), is highlighted and data supporting this hope will be presented, from in vitro and in vivo pre-clinical to clinical studies.
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12
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Vlahakos V, Marathias K, Lionaki S, Loukides S, Zakynthinos S, Vlahakos D. The Paradigm Shift from Polycythemia to Anemia in COPD: The Critical Role of the Renin-Angiotensin System Inhibitors. Expert Rev Respir Med 2022; 16:391-398. [PMID: 35212601 DOI: 10.1080/17476348.2022.2045958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although polycythemia has been considered a common adverse event in COPD, anemia is reported more often and has gained more importance than polycythemia over the last thirty years. AREAS COVERED Factors considered to be associated with the development of anemia in COPD have included: Aging and kidney dysfunction with erythropoietin deficiency and bone marrow suppression due to uremic toxins; heart failure (HF), which is often encountered in COPD and is accompanied by anemia in one third of the cases; Low-grade chronic inflammation, which can directly suppresses the bone marrow and diminish iron absorption and utilization via increased hepcidin levels; long-term oxygen therapy (LTOT), which ameliorates chronic hypoxia, and most important, RAS inhibitors, which are widely used for the co-morbidities associated with COPD (hypertension, HF, CKD, diabetes) and have previously been shown to lower hematocrit values or cause anemia in various clinical conditions. EXPERT OPINION Introduction of LTOT in COPD and especially the established use of RAS inhibitors form the basis for the shift from polycythemia to anemia in COPD. Interestingly, when the SGLT2 inhibitors are introduced for cardiorenal protection in COPD, one could anticipate correction of anemia or even reemergence of polycythemia, since this new class of drugs can augment erythropoietin secretion and increase hematocrit values.
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Affiliation(s)
- Vassilios Vlahakos
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos General Hospital, Athens, Greece
| | - Katerina Marathias
- Department of Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Sofia Lionaki
- 2nd Department of Medicine, Renal Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Spyros Zakynthinos
- 1 Department of Intensive Care Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos General Hospital, Athens, Greece
| | - Demetrios Vlahakos
- 2 Department of Medicine, Renal Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Kushkestani M, Parvani M, Moghadassi M, Kazemzadeh Y, Moradi K. Impact of Hypertension and Physical Fitness on SARS-COV-2 and Related Consequences. (Possible Mechanisms with Focusing on ACE2). Caspian J Intern Med 2022; 13:148-154. [PMID: 35872687 PMCID: PMC9272964 DOI: 10.22088/cjim.13.0.148] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 01/08/2023]
Abstract
Hypertension disease as an absolute risk factor of Covid-19 disease has been well-proven in recent evidence. The factors such as the use of antihypertensive drugs, protein expression, and compensatory axes resulted in hypertension disease playing very important roles in the occurrence of this problem. In this review study, we first attempted to investigate the higher chance reason for Covid-19 disease in people with high blood pressure; then we examined the related mechanisms, and finally, we reported the differences and similarities between people with high blood pressure and athletes. All in all, we concluded that people who exercise regularly, the same as hypertensive patients (Compensatory mechanism) are more susceptible to COVID-19 infection due to the high concentration of ACE2 (Physiological mechanism) caused by exercise adaptation, but for the low level of ANG2 (Systematic and gene expression) these individuals (Active subjects) indicate fewer complications and severity symptoms of COVID-19 such as dyspnea, hospitalization and, heart disease compared with hypertensive patients.
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Affiliation(s)
- Mehdi Kushkestani
- Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran,Correspondence: Mehdi Kushkestani, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran. E-mail: , Tel: 0098 2177863362 , Fax: 0098 2177863362
| | - Mohsen Parvani
- Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Mahsa Moghadassi
- Department of Exercise Physiology, Islamic Azad University, Tehran North Branch, Tehran, Iran
| | - Yaser Kazemzadeh
- Department of Exercise Physiology, Islamshahr branch, Islamic Azad University, Islamshahr, Iran
| | - Kiandokht Moradi
- Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
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14
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Tonon F, Tornese G, Giudici F, Nicolardi F, Toffoli B, Barbi E, Fabris B, Bernardi S. Children With Short Stature Display Reduced ACE2 Expression in Peripheral Blood Mononuclear Cells. Front Endocrinol (Lausanne) 2022; 13:912064. [PMID: 35909539 PMCID: PMC9335146 DOI: 10.3389/fendo.2022.912064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cause of short stature remains often unknown. The renin-angiotensin system contributes to growth regulation. Several groups reported that angiotensin-converting enzyme 2 (ACE2)-knockout mice weighed less than controls. Our case-control study aimed to investigate if children with short stature had reduced ACE2 expression as compared to controls, and its significance. MATERIALS AND METHODS children aged between 2 and 14 years were consecutively recruited in a University Hospital pediatric tertiary care center. Cases were children with short stature defined as height SD ≤ -2 diagnosed with growth hormone deficiency (GHD) or idiopathic short stature (ISS), before any treatment. Exclusion criteria were: acute diseases, kidney disease, endocrine or autoimmune disorders, precocious puberty, genetic syndromes, SGA history. ACE and ACE2 expression were measured in peripheral blood mononuclear cells, angiotensins were measured by ELISA. RESULTS Children with short stature displayed significantly lower ACE2 expression, being 0.40 fold induction (0.01-2.27) as compared to controls, and higher ACE/ACE2, with no differences between GHD and ISS. ACE2 expression was significantly and inversely associated with the risk of short stature, OR 0.26 (0.07-0.82), and it had a moderate accuracy to predict it, with an AUC of 0.73 (0.61-0.84). The cutoff of 0.45 fold induction of ACE2 expression was the value best predicting short stature, identifying correctly 70% of the children. CONCLUSIONS Our study confirms the association between the reduction of ACE2 expression and growth retardation. Further studies are needed to determine its diagnostic implications.
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Affiliation(s)
- Federica Tonon
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS ‘Burlo Garofolo’, Trieste, Italy
- *Correspondence: Gianluca Tornese,
| | - Fabiola Giudici
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesca Nicolardi
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Barbara Toffoli
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Egidio Barbi
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS ‘Burlo Garofolo’, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Stella Bernardi
- Department of Medical Surgical and Health Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
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15
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Hadadi A, Kazemian S, Shafie M, Ahmadi A, Soleimani A, Ashraf H. Effects of angiotensin receptor blockers (ARBs) on clinical outcomes of patients with hypertension and COVID-19: A 7-month follow-up cohort study. J Cardiovasc Thorac Res 2022; 14:253-257. [PMID: 36699557 PMCID: PMC9871165 DOI: 10.34172/jcvtr.2022.30559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/02/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, the use of angiotensin II receptor blockers (ARBs) in hypertensive patients with COVID-19 has been controversial. Following our previous study, after one year, we intended to extend our sample size and results to investigate the effects of ARBs with both in-hospital outcomes and 7-month follow-up results in patients with COVID-19. Methods: Patients with a diagnosis of COVID-19 who were admitted to Sina Hospital, Tehran, Iran, from February to October 2020 participated in this follow-up cohort study. The COVID-19 diagnosis was based on a positive polymerase chain reaction test or chest computed tomography scan according to guidelines. Patients were followed for disease severity, incurring in-hospital mortality, complications, and 7-month all-cause mortality. Results: We evaluated 1413 patients with COVID-19 in this study. After excluding 124 patients, 1289 including 561(43.5%) hypertensive patients, entered the analysis. During the study, 875(67.9%) severe disease, 227(17.6%) in-hospital mortality, and 307(23.8%) 7-month all-cause mortality were observed. After adjusting for possible confounders, ARB was not associated with severity, in-hospital and 7-month all-cause mortality, and in-hospital complications except for acute kidney injury. Discontinuation of ARBs was significantly associated with higher in-hospital mortality and 7-month all-cause mortality (both P values<0.006). We observed a better 7-month outcome in those who continued their ARBs after discharge. Conclusion: The results of this study, along with the previous studies, provide reassurance that taking ARBs is not associated with the risk of mortality, complications, and poorer outcomes in hypertensive COVID-19 patients after adjustment for possible confounders.
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Affiliation(s)
- Azar Hadadi
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran,Contributed equally to this study as co-first authors
| | - Sina Kazemian
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,Contributed equally to this study as co-first authors
| | - Mahan Shafie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,NeuroTRACT Association, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Ahmadi
- Department of Anesthesiology and Critical Care, Sina Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Soleimani
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author: Haleh Ashraf,
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16
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Liu Y, Hao H, Lan T, Jia R, Cao M, Zhou L, Zhao Z, Pan W. Physiological and pathological roles of Ang II and Ang- (1-7) in the female reproductive system. Front Endocrinol (Lausanne) 2022; 13:1080285. [PMID: 36619582 PMCID: PMC9817105 DOI: 10.3389/fendo.2022.1080285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
The local Renin-Angiotensin System (RAS) has been demonstrated to exist in a wide range of tissues and organs, In the female reproductive system, it is mainly found in the ovary, uterus and placenta. The RAS system is made up of a series of active substances and enzymes, in addition to the circulating endocrine renin-angiotensin system. The active peptides Angiotensin II (Ang II) and Angiotensin (1-7) (Ang-(1-7)), in particular, appear to have distinct activities in the local RAS system, which also controls blood pressure and electrolytes. Therefore, in addition to these features, angiotensin and its receptors in the reproductive system seemingly get involved in reproductive processes, such as follicle growth and development, as well as physiological functions of the placenta and uterus. In addition, changes in local RAS components may induce reproductive diseases as well as pathological states such as cancer. In most tissues, Ang II and Ang- (1-7) seem to maintain antagonistic effects, but this conclusion is not always true in the reproductive system, where they play similar functions in some physiological and pathological roles. This review investigated how Ang II, Ang- (1-7) and their receptors were expressed, localized, and active in the female reproductive system. This review also summarized their effects on follicle development, uterine and placental physiological functions. The changes of local RAS components in a series of reproductive system diseases including infertility related diseases and cancer and their influence on the occurrence and development of diseases were elucidated. This article reviews the physiological and pathological roles of Ang II and Ang- (1-7) in female reproductive system,a very intricate system of tissue factors that operate as agonists and antagonists was found. Besides, the development of novel therapeutic strategies targeting components of this system may be a research direction in future.
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Affiliation(s)
- Yuanyuan Liu
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haomeng Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tingting Lan
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Jia
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Mingya Cao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liang Zhou
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiming Zhao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Wensen Pan, ; Zhiming Zhao,
| | - Wensen Pan
- Second Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- *Correspondence: Wensen Pan, ; Zhiming Zhao,
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17
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Kulkarni PG, Sakharkar A, Banerjee T. Understanding the role of nACE2 in neurogenic hypertension among COVID-19 patients. Hypertens Res 2022; 45:254-69. [PMID: 34848886 DOI: 10.1038/s41440-021-00800-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
Currently, the third and fourth waves of the coronavirus disease -19 (COVID-19) pandemic are creating havoc in many parts of the world. Although vaccination programs have been launched in most countries, emerging new strains of the virus along with geographical variations are leading to varying success rates of the available vaccines. The presence of comorbidities such as diabetes, cardiovascular diseases and hypertension is responsible for increasing the severity of COVID-19 and, thus, the COVID-19 mortality rate. Angiotensin-converting enzyme 2 (ACE2), which is utilized by SARS-CoV-2 for entry into host cells, is widely expressed in the lungs, kidneys, testes, gut, adipose tissue, and brain. Infection within host cells mediates RAS overactivation, which leads to a decrease in the ACE2/ACE ratio, AT2R/AT1R ratio, and MasR/AT1R ratio. Such imbalances lead to the development of heightened inflammatory responses, such as cytokine storms, leading to post-COVID-19 complications and mortality. As the association of SARS-CoV-2 infection and hypertension remains unclear, this report provides an overview of the effects of SARS-CoV-2 infection on patients with hypertension. We discuss here the interaction of ACE2 with SARS-CoV-2, focusing on neuronal ACE2 (nACE2), and further shed light on the possible involvement of nACE2 in hypertension. SARS-CoV-2 enters the brain through neuronal ACE2 and spreads in various regions of the brain. The effect of viral binding to neuronal ACE2 in areas of the brain that regulate salt/water balance and blood pressure is also discussed in light of the neural regulation of hypertension in COVID-19.
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18
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Noto NM, Restrepo YM, Speth RC. Countering the classical renin-angiotensin system. Clin Sci (Lond) 2021; 135:2619-23. [PMID: 34878506 DOI: 10.1042/CS20211043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022]
Abstract
It is well-established that Ang-(1-7) counteracts the effects of Ang II in the periphery, while stimulating vasopressin release and mimicking the activity of Ang II in the brain, through interactions with various receptors. The rapid metabolic inactivation of Ang-(1-7) has proven to be a limitation to therapeutic administration of the peptide. To circumvent this problem, Alves et al. (Clinical Science (2021) 135(18), https://doi.org/10.1042/CS20210599) developed a new transgenic rat model that overexpresses an Ang-(1-7)-producing fusion protein. In this commentary, we discuss potential concerns with this model while also highlighting advances that can ensue from this significant technical feat.
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19
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Georges JL, Cochet H, Roger G, Ben Jemaa H, Soltani J, Azowa JB, Mamou R, Gilles F, Saba J, Prevot A, Pasqualini M, Monguillon V, De Tournemire M, Bertrand A, Koukabi-Fradelizi M, Beressi JP, Livarek B. [Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study]. Ann Cardiol Angeiol (Paris) 2020; 69:247-254. [PMID: 33039120 PMCID: PMC7522617 DOI: 10.1016/j.ancard.2020.09.030] [Citation(s) in RCA: 8] [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: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for cell entry into lung cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there are concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection or severity. This study sought to analyse the association of severe forms of COVID-19 and mortality with hypertension and a previous treatment with ACEI and ARB. METHODS Prospective follow-up of 433 consecutive patients hospitalised for COVID-19 pneumonia confirmed by PCR or highly probable on clinical, biological, and radiological findings, and included in the COVHYP study. Mortality and severe COVID-19 (criteria: death, intensive care unit, or hospitalisation >30 days) were compared in patients receiving or not ACEIs and ARBs. Follow-up was 100% at hospital discharge, and 96.5% at >1month. RESULTS Age was 63.6±18.7 years, and 40%) were female. At follow-up (mean 78±50 days), 136 (31%) patients had severity criteria (death, 64 ; intensive care unit, 73; hospital stay >30 days, 49). Hypertension (55.1% vs 36.7%, P<0.001) and antihypertensive treatment were associated with severe COVID-19 and mortality. The association between ACEI/ARB treatment and COVID-19 severity criteria found in univariate analysis (Odds Ratio 1.74, 95%CI [1.14-2.64], P=0.01) was not confirmed when adjusted on age, gender, and hypertension (adjusted OR1.13 [0.59-2.15], P=0.72). Diabetes and hypothyroidism were associated with severe COVID-19, whereas history of asthma was not. CONCLUSION This study suggests that previous treatment with ACEI and ARB is not associated with hospital mortality, 1- and 2-month mortality, and severity criteria in patients hospitalised for COVID-19. No protective effect of ACEIs and ARBs on severe pneumonia related to COVID-19 was demonstrated.
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Affiliation(s)
- J-L Georges
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
| | - H Cochet
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - G Roger
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - H Ben Jemaa
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - J Soltani
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - J-B Azowa
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - R Mamou
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - F Gilles
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - J Saba
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - A Prevot
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - M Pasqualini
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - V Monguillon
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - M De Tournemire
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - A Bertrand
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - M Koukabi-Fradelizi
- Service d'accueil des urgences, Centre Hospitalier de Versailles, Le Chesnay, France
| | - J-P Beressi
- Service de diabétologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - B Livarek
- Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France
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Abstract
There is considerable interest in traumatic brain injury (TBI) induced by repeated concussions suffered by athletes in sports, military personnel from combat-and non-combat related activities, and civilian populations who suffer head injuries from accidents and domestic violence. Although the renin-angiotensin system (RAS) is primarily a systemic cardiovascular regulatory system that, when dysregulated, causes hypertension and cardiovascular pathology, the brain contains a local RAS that plays a critical role in the pathophysiology of several neurodegenerative diseases. This local RAS includes receptors for angiotensin (Ang) II within the brain parenchyma, as well as on circumventricular organs outside the blood-brain-barrier. The brain RAS acts primarily via the type 1 Ang II receptor (AT1R), exacerbating insults and pathology. With TBI, the brain RAS may contribute to permanent brain damage, especially when a second TBI occurs before the brain recovers from an initial injury. Agents are needed that minimize the extent of injury from an acute TBI, reducing TBI-mediated permanent brain damage. This review discusses how activation of the brain RAS following TBI contributes to this damage, and how drugs that counteract activation of the AT1R including AT1R blockers (ARBs), renin inhibitors, angiotensin-converting enzyme (ACE) inhibitors, and agonists at type 2 Ang II receptors (AT2) and at Ang (1-7) receptors (Mas) can potentially ameliorate TBI-induced brain damage.
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Affiliation(s)
- Jason D Vadhan
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Robert C Speth
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, United States of America; School of Medicine, Georgetown University, Washington, DC, United States of America.
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21
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Bragina ME, Costa-Fraga F, Sturny M, Ebadi B, Ruoccolo RT, Santos RAS, Fraga-Silva RA, Stergiopulos N. Characterization of the Renin-Angiotensin System in Aged Cavernosal Tissue and its Role in Penile Fibrosis. J Sex Med 2020; 17:2129-2140. [PMID: 32943375 DOI: 10.1016/j.jsxm.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The renin-angiotensin system (RAS) plays an important role in erectile function. The RAS contains 2 major axes: one deleterious, composed of ACE-Ang II-AT1 receptor, and another protective, composed of ACE2-Ang-(1-7)-Mas receptor. While aging is a well-known cause for development of male sexual disorders, little is known about local regulation of the RAS in age-related erectile dysfunction (ED). AIM The present study aimed to assess regulation of the RAS in aging-associated ED rat model and evaluate possible options for disease management through pharmacological modulation of the RAS. METHODS Penile tissues were harvested from 3-, 12-, and 24-month-old Wistar rats. Local expression of major RAS components and ED markers was measured by RT-PCR. Protein expression of RAS components was assessed by western blot. Collagen deposition was measured by Sirius Red and immunohistochemical staining. Evaluation of collagen content was also performed in penile sections of Mas-knockout mice by Sirius Red and Masson's trichrome stainings. Finally, the effect of Ang-(1-7) pretreatment on TGF-β-induced myofibroblast activation was studied in primary cavernosal and immortalized fibroblasts. OUTCOMES Experimental results highlighted the essential role of the RAS in modulation of cavernosal fibrosis. RESULTS The present study demonstrates local expression of angiotensinogen mRNA alongside with major RAS components, which suggests local autonomous functioning of the RAS within penile tissue. Gene expression analysis revealed strong positive correlation between ACE-Ang II-AT1 axis with markers for inflammation and fibrosis. While corpus cavernosum from 24-month-old rats was characterized by increased collagen deposition, protein expression of ACE, AT1, and Mas was shown to be upregulated in the penile tissue of this group. At the same time, penile sections from Mas-knockout mice (FVB/N background) were also shown to have increased collagen deposition. Finally, it was demonstrated that Ang-(1-7) treatment of primary cavernosal and immortalized fibroblasts was able to alleviate TGF-β-induced fibroblast-to-myofibroblast transition. CLINICAL TRANSLATION The present study suggests Ang-(1-7) treatment as a possible strategy for pharmacological management of fibrosis-associated ED in aging. STRENGTHS & LIMITATIONS The link between the RAS and penile fibrosis, indicated by a holistic screening of different ED markers, was confirmed by in vivo and in vitro data. However, results, presented in the manuscript, need to be further reinforced by human data. Important to note, the main goal of the study was to characterize RAS regulation in aging condition rather than state any causal relationships. CONCLUSION Present study characterizes RAS regulation in aging-associated ED and indicates its important role in cavernosal fibrosis. Bragina ME, Costa-Fraga F, Sturny M, et al. Characterization of the Renin-Angiotensin System in Aged Cavernosal Tissue and its Role in Penile Fibrosis. J Sex Med 2020;17:2129-2140.
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Affiliation(s)
- Maiia E Bragina
- Laboratory of Hemodynamics and Cardiovascular Technology, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Fabiana Costa-Fraga
- Laboratory of Hemodynamics and Cardiovascular Technology, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Mikaël Sturny
- Laboratory of Hemodynamics and Cardiovascular Technology, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Babak Ebadi
- Laboratory of Hemodynamics and Cardiovascular Technology, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Rafael T Ruoccolo
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Robson A S Santos
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo A Fraga-Silva
- Laboratory of Hemodynamics and Cardiovascular Technology, École polytechnique fédérale de Lausanne, Lausanne, Switzerland.
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
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22
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do Amaral CMCA, Casarini DE, Andrade MC, da Cruz ML, Macedo A. Study of serum and urinary markers of the renin-angiotensin-aldosterone system in myelomeningocele patients with renal injury detected by DMSA. Int Braz J Urol 2020; 46:805-813. [PMID: 32648420 PMCID: PMC7822362 DOI: 10.1590/s1677-5538.ibju.2019.0797] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/16/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: The Renin-Angiotensin-Aldosterone System (RAAS) has been suggested as a possible marker of renal injury in chronic diseases. This study proposes to analyze the serum and urinary markers of the RAAS in myelomeningocele patients with renal function abnormalities detected on DMSA. Material and Methods: Seventeen patients followed in our institution that presented with renal injury on DMSA. We review nephrologic and urologic clinical aspects and evaluated ultrassonagraphy, voiding urethrocystography and urodynamics. Urinary and serum samples were collected to evaluate possible correlations of renal lesions with RAAS. Control group urine and serum samples were also sent for analysis. Results: Serum ACE 2 activity means in relation to urodynamic findings were the only values that had a statistically significant difference (p = 0.040). Patients with normal bladder pattern presented higher ACE 2 levels than the high risk group. Statistical analysis showed that the study group (SG) had a significantly higher mean serum ACE than the CG. The means of ACE 2 and urinary ACE of the SG and CG were not statistically different. The ROC curve for serum ACE values had a statistically significant area for case and non-case differentiation, with 100% sensitivity and 53% specificity for values above 60.2 mg/dL. No statistically significant areas were observed in relation to ACE 2 and urinary ACE values between SG and CG. Conclusion: The analysis of serum ACE, ACE 2 and urinary ACE were not significant in patients with myelomeningocele and neurogenic bladder with renal injury previously detected by renal DMSA.
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Affiliation(s)
| | - Dulce Elena Casarini
- Departamento de Pediatria, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Maria Cristina Andrade
- Departamento de Pediatria, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcela Leal da Cruz
- Departamento de Urologia, Centro de Apoio à Criança com Anomalia Urológica -CACAU - Núcleo de Urologia Pediátrica - NUPEP, São Paulo, SP, Brasil
| | - Antônio Macedo
- Departamento de Pediatria, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Urologia, Centro de Apoio à Criança com Anomalia Urológica -CACAU - Núcleo de Urologia Pediátrica - NUPEP, São Paulo, SP, Brasil
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23
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Laville SM, Gras-Champel V, Moragny J, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Stengel B, Massy ZA, Liabeuf S. Adverse Drug Reactions in Patients with CKD. Clin J Am Soc Nephrol 2020; 15:1090-1102. [PMID: 32611662 PMCID: PMC7409761 DOI: 10.2215/cjn.01030120] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the burden of adverse drug reactions in CKD. We estimated the incidence of overall and serious adverse drug reactions and assessed the probability of causation, preventability, and factors associated with adverse drug reactions in patients seen by nephrologists. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Kidney Disease-Renal Epidemiology and Information Network cohort included 3033 outpatients (65% men) with CKD and eGFR<60 ml/min per 1.73 m2, with follow-up for 2 years. Adverse drug reactions were identified from hospitalization reports, medical records, and participant interviews and finally assessed for causality, preventability, and immediate therapeutic management by experts in pharmacology. RESULTS Median (interquartile range) age was 69 (60-76) years old; 55% had eGFR≥30 ml/min per 1.73 m2, and 45% had eGFR<30 ml/min per 1.73 m2. Participants were prescribed a median (range) of eight (five to ten) drugs. Over 2 years, 536 patients had 751 adverse drug reactions, 150 (in 125 participants) classified as serious, for rates of 14.4 (95% confidence interval, 12.6 to 16.5) and 2.7 (95% confidence interval, 1.7 to 4.3) per 100 person-years, respectively. Among the serious adverse drug reactions, 32% were considered preventable or potentially preventable; 16 caused death, directly or indirectly. Renin-angiotensin system inhibitors (15%), antithrombotic agents (14%), and diuretics (10%) were the drugs to which the most adverse drug reactions were imputed, but antithrombotic agents caused 34% of serious adverse drug reactions. The drug was discontinued in 71% of cases, at least temporarily. Adjusted hazard ratios for serious adverse drug reaction were significantly higher in patients with eGFR<30 versus ≥30 ml/min per 1.73 m2 (1.8; 95% confidence interval, 1.3 to 2.6), in those prescribed more than ten versus less than five medications (2.4; 95% confidence interval, 1.1 to 5.2), or in those with poor versus good adherence (1.6; 95% confidence interval, 1.4 to 2.4). CONCLUSIONS Adverse drug reactions are common and sometimes serious in patients with CKD. Many serious adverse drug reactions may be preventable. Some specific pharmacologic classes, particularly antithrombotic agents, are at risk of serious adverse drug reactions. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN), NCT03381950.
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Affiliation(s)
- Solène M Laville
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | | | - Julien Moragny
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Christian Jacquelinet
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Renal Epidemiology and Information Network Registry, Biomedicine Agency, Saint Denis, France
| | - Christian Combe
- Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm Unit 1026, University of Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Maurice Laville
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- Nephrology Department, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Division of Nephrology, Ambroise Paré University Hospital, Assistance publique - Hôpitaux de Paris, Boulogne-Billancourt/Paris, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
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24
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Lanza K, Perez LG, Costa LB, Cordeiro TM, Palmeira VA, Ribeiro VT, Simões E Silva AC. Covid-19: the renin-angiotensin system imbalance hypothesis. Clin Sci (Lond) 2020; 134:1259-64. [PMID: 32507883 DOI: 10.1042/CS20200492] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
The emergency of SARS-CoV-2 in China started a novel challenge to the scientific community. As the virus turns pandemic, scientists try to map the cellular mechanisms and pathways of SARS-CoV-2 related to the pathogenesis of Coronavirus Disease 2019 (Covid-19). After transmembrane angiotensin-converting enzyme 2 (ACE2) has been found to be SARS-CoV-2 receptor, we hypothesized an immune-hematological mechanism for Covid-19 based on renin–angiotensin system (RAS) imbalance to explain clinical, laboratory and imaging findings on disease course. We believe that exaggerated activation of ACE/Angiotensin II (Ang II)/Angiotensin Type 1 (AT1) receptor RAS axis in line with reduction of ACE2/Angiotensin-(1-7)/Mas receptor may exert a pivotal role in the pathogenesis of Covid-19. In this perspective, we discuss potential mechanisms and evidence on this hypothesis.
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25
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He MC, Shi Z, Qin M, Sha NN, Li Y, Liao DF, Lin FH, Shu B, Sun YL, Yuan TF, Wang YJ, Zhang Y. Muscone Ameliorates LPS-Induced Depressive-Like Behaviors and Inhibits Neuroinflammation in Prefrontal Cortex of Mice. Am J Chin Med 2020; 48:559-577. [PMID: 32345030 DOI: 10.1142/s0192415x20500287] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression is partially caused by inflammation in the central nervous system. Early study demonstrated that musk, glandular secretion from male musk deer, exerted an antidepressant-like effect. The aim of this study was to investigate if muscone, a bioactive ingredient in musk, could ameliorate neuroinflammation and depressive-like behaviors as well as explore the potential action mechanism. Mice were intraperitoneally (i.p.) injected with muscone for 2 weeks prior to administration of lipopolysaccharides (LPS, 1mg/kg, i.p.). Pre-treatment with muscone reversed the LPS-induced decrease in body weight within 24h and ameliorated depressive-like behaviors shown by sucrose preference, tail suspension test, and forced swimming test. LPS-induced activation of microglial cells and elevation in expression of inflammatory cytokines including IL-1β, RANTES, and MCP-1 in the prefrontal cortex of mice were effectively abrogated by muscone, which significantly down-regulated expression of TLR4, MyD88, Caspase-1, NLRP3, renin, and Ang II. In addition, treatment of BV2 microglia cells with muscone markedly attenuated the LPS-induced rise in protein expression of TLR4, Ang II, and IL-1β. This study revealed that muscone could ameliorate LPS-induced depressive-like behaviors by repressing neuroinflammation in the prefrontal cortex of mice caused by its suppression on microglia activation and production of inflammatory cytokines via acting on TLR4 pathway and RAS cascade.
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Affiliation(s)
- Ming-Chao He
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, P. R. China
| | - Zhe Shi
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 201108, P. R. China.,Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha 410208, P. R. China
| | - Meng Qin
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Nan-Nan Sha
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China
| | - Yue Li
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, P. R. China
| | - Duan-Fang Liao
- Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha 410208, P. R. China
| | - Fu-Hui Lin
- Department of Orthopaedic, Shenzhen Pingle Orthopaedic Hospital, Shenzhen 518000, P. R. China
| | - Bing Shu
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, P. R. China
| | - Yue-Li Sun
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, P. R. China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 201108, P. R. China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, P. R. China
| | - Yong-Jun Wang
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, P. R. China
| | - Yan Zhang
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P. R. China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, P. R. China
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26
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Affiliation(s)
- Marie-Michèle Gaudreault-Tremblay
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bethany J Foster
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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27
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van den Belt SM, Heerspink HJL, Kirchner M, Gracchi V, Thurn-Valsassina D, Bayazit AK, Niemirska A, Canpolat N, Kaplan Bulut I, Azukaitis K, Duzova A, Bacchetta J, Shroff R, Paripovic D, Özçakar ZB, Fidan K, Erdogan H, Gellermann J, Wühl E, de Zeeuw D, Melk A, Querfeld U, Schaefer F. Discontinuation of RAAS Inhibition in Children with Advanced CKD. Clin J Am Soc Nephrol 2020; 15:625-632. [PMID: 32253275 PMCID: PMC7269205 DOI: 10.2215/cjn.09750819] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Although renin-angiotensin-aldosterone system inhibition (RAASi) is a cornerstone in the treatment of children with CKD, it is sometimes discontinued when kidney function declines. We studied the reasons of RAASi discontinuation and associations between RAASi discontinuation and important risk markers of CKD progression and on eGFR decline in the Cardiovascular Comorbidity in Children with CKD study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this study, 69 children with CKD (67% male, mean age 13.7 years, mean eGFR 27 ml/min per 1.73 m2) who discontinued RAASi during prospective follow-up were included. Initial change in BP, albuminuria, and potassium after discontinuation were assessed (median time 6 months). Rate of eGFR decline (eGFR slope) during a median of 1.9 years before and 1.2 years after discontinuation were estimated using linear mixed effects modeling. RESULTS Physician-reported reasons for RAASi discontinuation were increase in serum creatinine, hyperkalemia, and symptomatic hypotension. After discontinuation of RAASi, BP and albuminuria increased, whereas potassium decreased. eGFR declined more rapidly after discontinuation of RAASi (-3.9 ml/min per 1.73 m2 per year; 95% confidence interval, -5.1 to -2.6) compared with the slope during RAASi treatment (-1.5 ml/min per 1.73 m2 per year; 95% confidence interval, -2.4 to -0.6; P=0.005). In contrast, no change in eGFR slope was observed in a matched control cohort of patients in whom RAASi was continued. CONCLUSIONS Discontinuation of RAASi in children with CKD is associated with an acceleration of kidney function decline, even in advanced CKD.
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Affiliation(s)
- Sophie M van den Belt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Valentina Gracchi
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniela Thurn-Valsassina
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Aysun K Bayazit
- Department of Pediatric Nephrology, Cukurova University School of Medicine, Adana, Turkey
| | - Anna Niemirska
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Nur Canpolat
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ipek Kaplan Bulut
- Division of Pediatric Nephrology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Rukshana Shroff
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children and Institute of Child Health, London, United Kingdom
| | - Dusan Paripovic
- Department of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | - Zeynep Birsin Özçakar
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Ankara University, Ankara, Turkey
| | - Kibriya Fidan
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Hakan Erdogan
- Department of Nephrology, Bursa Yuksek Ihtisas Teaching and Researching Hospital, Bursa, Turkey
| | - Jutta Gellermann
- Division of Gastroenterology, Nephrology, and Metabolic Medicine, Department of Pediatrics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Uwe Querfeld
- Division of Gastroenterology, Nephrology, and Metabolic Medicine, Department of Pediatrics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, University Hospital Heidelberg, Heidelberg, Germany
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28
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Sparks MA, South A, Welling P, Luther JM, Cohen J, Byrd JB, Burrell LM, Batlle D, Tomlinson L, Bhalla V, Rheault MN, Soler MJ, Swaminathan S, Hiremath S. Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19. Clin J Am Soc Nephrol 2020; 15:714-716. [PMID: 32220930 PMCID: PMC7269218 DOI: 10.2215/cjn.03530320] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Matthew A Sparks
- Division of Nephrology, Department of Medicine, Duke University School of Medicine and Durham VA Health System, Durham, North Carolina
| | - Andrew South
- Section of Nephrology, Department of Pediatrics, Department of Epidemiology & Prevention, Division of Public Health Sciences, Department of Surgery-Hypertension & Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Paul Welling
- Joseph S and Esther Handler Professor, Departments of Medicine (Nephrology) and Physiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - J Matt Luther
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Hypertension Center, Nashville, Tennessee
| | - Jordana Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James Brian Byrd
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Louise M Burrell
- Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Daniel Batlle
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Nephrology, Chicago, Illinois
| | - Laurie Tomlinson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vivek Bhalla
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, California
| | - Michelle N Rheault
- Division of Pediatric Nephrology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - María José Soler
- Division of Nephrology, Hospital Universitari Vall d'Hebron, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Sundar Swaminathan
- Division of Nephrology and Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Virginia
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
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Mercado M. The renin-angiotensin-aldosterone system and its inhibitors in the context of the COVID-19 pandemic. Rev Med Inst Mex Seguro Soc 2020; 58:378-380. [PMID: 34543540 DOI: 10.24875/rmimss.m20000059] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Una de las confusiones que ha generado la pandemia de COVID-19 es la idea de que los inhibidores de la enzima convertidora de la angiotensina y los antagonistas del receptor de la angiotensina II de tipo 1 pueden agravar el daño pulmonar inducido por el SARS-CoV-2 en pacientes de edad avanzada. En este breve comunicado se analiza, desde una perspectiva crítica, la evidencia científica que secunda esta asociación. One of the confusions aroused by the outbreak of COVID-19 pandemic is the idea that angiotensin converting enzyme inhibitors and type 1 angiotensin II receptor may aggravate the lung damage induced by SARS CoV-2 virus in older adult patients. In this brief statement, the scientific evidence supporting this association is analyzed from a critical perspective.
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Affiliation(s)
- Moisés Mercado
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Unidad de Investigación Médica en Enfermedades Endocrinas. Ciudad de México, México
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30
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Affiliation(s)
- Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom; and
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine Non-Communicable Disease Epidemiology, London, United Kingdom
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31
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Rachid MA, da Silva Camargos ER, Marzano LAS, da Silva Oliveira B, Ferreira RN, Martinelli PM, Teixeira AL, Miranda AS, Simões E Silva AC. Effect of blockade of nitric oxide in heart tissue levels of Renin Angiotensin System components in acute experimental Chagas disease. Life Sci 2019; 219:336-342. [PMID: 30684542 DOI: 10.1016/j.lfs.2019.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/09/2019] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Abstract
Chagas disease (CD) is an important cause of cardiomyopathy in South America. The pathophysiology of CD is still a matter of debate. Renin Angiotensin System (RAS) components are clearly involved in cardiovascular diseases. RAS molecules interact with nitric oxide (NO) pathway in blood vessel and heart tissue. Thus, the aim of this study is to investigate possible changes in RAS molecules during the infection with Y strain T. cruzi and in response to acute administration of an inhibitor of the enzyme NO synthase, l-NAME. Male Holtzman rats were inoculated intraperitoneally with Y strain T. cruzi and received l-NAME or tap water from one day before the infection until 13 or 17 days post infection (dpi). Angiotensin converting enzyme 1 (ACE1) levels were significantly higher at day 17 when compared to baseline in atrium, whereas, in ventricle, ACE2 levels were significantly higher in 13 dpi when compared to baseline. In response to l-NAME treatment, atrium tissue levels of ACE1 were significantly reduced in treated animals at day 17, while Angiotensin-(1-7) concentration in atrium significantly increased in this group at the same time-point. No changes were detected in RAS components in the ventricle. ACE2 levels in Soleus muscle were significantly reduced in treated animals at day 13. In conclusion, changes in RAS molecules were detected during acute phase of T. cruzi infection and the inhibition of NO synthesis clearly interfered with expression of ACE1 and Angiotensin-(1-7) in the atrium.
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Affiliation(s)
- Milene Alvarenga Rachid
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Bruna da Silva Oliveira
- Departamento de Morfologia, Instituto de Ciências Biológicas, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo Novaes Ferreira
- Departamento de Morfologia, Instituto de Ciências Biológicas, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | | | - Antônio Lúcio Teixeira
- Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aline Silva Miranda
- Departamento de Morfologia, Instituto de Ciências Biológicas, UFMG, Belo Horizonte, Minas Gerais, Brazil; Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, UFMG, Belo Horizonte, Minas Gerais, Brazil.
| | - Ana Cristina Simões E Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, UFMG, Belo Horizonte, Minas Gerais, Brazil
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32
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de Jong MA, Petrykiv SI, Laverman GD, van Herwaarden AE, de Zeeuw D, Bakker SJL, Heerspink HJL, de Borst MH. Effects of Dapagliflozin on Circulating Markers of Phosphate Homeostasis. Clin J Am Soc Nephrol 2018; 14:66-73. [PMID: 30559106 PMCID: PMC6364523 DOI: 10.2215/cjn.04530418] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/20/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The sodium glucose cotransporter 2 (SGLT-2) inhibitor dapagliflozin is a novel drug for the treatment of diabetes mellitus. Recent studies suggest that SGLT-2 inhibitors affect phosphate homeostasis, but their effects on phosphate-regulating hormones in patients with diabetic kidney disease are still unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a post-hoc analysis of a double-blind, randomized, crossover trial in patients with type 2 diabetes with early-stage diabetic kidney disease on stable renin-angiotensin-aldosterone system blockade, with an albumin-to-creatinine ratio between 100 and 3500 mg/g, eGFR≥45 ml/min per 1.73 m2, and glycosylated hemoglobin≥7.2% and <11.4%. Patients were randomized to dapagliflozin 10 mg/d or placebo during consecutive 6-week study periods, separated by a 6-week wash-out. We investigated effects on circulating phosphate, calcium, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D (25[OH]D), and 1,25-dihydroxyvitamin D (1,25[OH]2D) levels. RESULTS Thirty-one patients (age 62 years; 23% female) were analyzed. Compared with placebo, dapagliflozin increased serum phosphate by 9% (95% confidence interval, 4% to 15%; P=0.002), PTH increased by 16% (3% to 30%; P=0.01), FGF23 increased by 19% (0.3% to 42%; P=0.05), and serum 1,25(OH)2D decreased by -12% (-25% to 4%; P=0.12). Calcium and 25(OH)D were unaffected. We found no correlation between changes in markers of phosphate homeostasis and changes in eGFR or 24-hour albumin excretion during dapagliflozin treatment. CONCLUSIONS Dapagliflozin increases serum phosphate, plasma PTH, and FGF23. This effect was independent of concomitant changes in eGFR or 24-hour albumin excretion.
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Affiliation(s)
| | - Sergei I Petrykiv
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gozewijn D Laverman
- Department of Nephrology, Zorggroep Twente, Almelo and Hengelo, The Netherlands; and
| | | | - Dick de Zeeuw
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Hiddo J L Heerspink
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Yamamoto R, Shinzawa M, Isaka Y, Yamakoshi E, Imai E, Ohashi Y, Hishida A. Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD. Clin J Am Soc Nephrol 2018; 13:1825-1832. [PMID: 30442866 PMCID: PMC6302324 DOI: 10.2215/cjn.01340118] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 01/29/2018] [Accepted: 08/23/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Shorter or longer sleep duration and poor sleep quality are risk factors for numerous cardio-metabolic diseases, cardiovascular disease, and mortality in subjects with normal kidney function. The association of sleep duration and sleep quality with health outcomes in patients with CKD remains uncertain. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A 4-year prospective cohort study in 17 nephrology centers in Japan, the CKD Japan Cohort (CKD-JAC) Study, assessed an association of self-reported sleep duration and sleep quality, on the basis of the Pittsburgh Sleep Quality Index (PSQI) questionnaire, with incidence of ESKD in 1601 patients with eGFR 10-59 ml/min per 1.73 m2 using multivariable-adjusted Cox proportional hazards models. RESULTS Baseline sleep duration and PSQI global score for the 1601 patients were mean±SD 7.0±1.3 hours and median 4 (interquartile range, 3-7), respectively. Poor sleep quality (PSQI global score ≥6) was common (n=588 [37%]). During a median of 4.0 (2.6-4.3) years of the follow-up period, 282 (18%) patients progressed to ESKD. After adjusting for age, sex, eGFR, urinary albumin excretion, smoking status, body mass index, history of diabetes and cardiovascular disease, systolic BP, blockade of the renin-angiotensin system, use of hypnotics, and Beck depression inventory score, both shorter (≤5 hour) and longer (>8 hour) sleep duration were associated with ESKD (adjusted hazard ratios [95% confidence intervals] for ≤5.0, 5.1-6.0, 6.1-7.0, 7.1-8.0, and ≥8.0 hours were 2.05 [1.31 to3.21], 0.98 [0.67 to 1.44], 1.00 [reference], 1.22 [0.89 to 1.66], and 1.48 [1.01 to 2.16]), suggesting a U-shaped relationship between sleep duration and ESKD. PSQI global score ≥6 was also associated with incidence of ESKD (adjusted hazard ratios [95% confidence intervals] for PSQI global score ≤5 and ≥6 were 1.00 [reference] and 1.33 [1.03 to 1.71]). CONCLUSIONS Shorter (≤5 hour) and longer (>8 hour) sleep duration and poor sleep quality (PSQI global score ≥6) were associated with ESKD in patients with CKD.
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Affiliation(s)
- Ryohei Yamamoto
- Health Care Division, Health and Counseling Center, Osaka University, Toyonaka, Osaka, Japan
| | - Maki Shinzawa
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Hyogo, Japan
| | | | | | - for the CKD-JAC Investigators
- Health Care Division, Health and Counseling Center, Osaka University, Toyonaka, Osaka, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Statcom Company Limited, Bunkyo-Ku, Tokyo, Japan
- Nakayamadera Imai Clinic, Takarazuka, Hyogo, Japan
- Chuo University Bunkyo-ku, Tokyo, Japan; and
- Yaizu City Hospital, Yaizu, Shizuoka, Japan
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Wunpathe C, Potue P, Maneesai P, Bunbupha S, Prachaney P, Kukongviriyapan U, Kukongviriyapan V, Pakdeechote P. Hesperidin Suppresses Renin-Angiotensin System Mediated NOX2 Over-Expression and Sympathoexcitation in 2K-1C Hypertensive Rats. Am J Chin Med 2018; 46:751-767. [PMID: 29754503 DOI: 10.1142/s0192415x18500398] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hesperidin, a flavonoid derived from citrus fruits, possesses several beneficial effects including anti-oxidation and anti-inflammation. The aim of this study was to investigate the effects of hesperidin on the renin-angiotensin system (RAS) cascade that mediated oxidative stress and sympathoexcitation in two-kidney, one-clipped (2K-1C) hypertensive rats. 2K-1C hypertension was induced in male Sprague-Dawley rats. Hypertensive rats were treated with hesperidin at 20[Formula: see text]mg/kg or 40[Formula: see text]mg/kg or losartan at 10[Formula: see text]mg/kg beginning at three weeks after surgery and then continued for four weeks ([Formula: see text]/group). Hesperidin reduced blood pressure in a dose-dependent manner in hypertensive rats compared to untreated rats ([Formula: see text]). Increased plasma angiotensin converting enzyme (ACE) activity and angiotensin II levels, as well as, upregulated AT1 receptor protein expression in aortic tissues were attenuated in hypertensive rats treated with hesperidin. Hesperidin suppressed oxidative stress markers and NADPH oxidase over-expression, and restored plasma nitric oxide metabolites in 2K-1C rats. This was associated with improvement of the vascular response to acetylcholine in isolated mesenteric vascular beds and aortic rings from 2K-1C rats treated with hesperidin ([Formula: see text]). Enhancement of nerve-mediated vasoconstriction related to high plasma noradrenaline in the 2K-1C group was alleviated by hesperidin treatment ([Formula: see text]). Furthermore, losartan exhibited antihypertensive effects by suppressing the RAS cascade and oxidative stress and improved vascular dysfunction observed in 2K-1C rats ([Formula: see text]). Based on these results, it can be presumed that hesperidin is an antihypertensive agent. Its antihypertensive action might be associated with reducing RAS cascade-induced NOX2 over-expression and sympathoexcitation in 2K-1C hypertensive rats.
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Affiliation(s)
- Chutamas Wunpathe
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Prapassorn Potue
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Putcharawipa Maneesai
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sarawoot Bunbupha
- ¶ Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Parichat Prachaney
- † Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Upa Kukongviriyapan
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | | | - Poungrat Pakdeechote
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
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35
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Affiliation(s)
- Lili Tong
- Department of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Torrance, California
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36
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Silver SA, Bell CM, Chertow GM, Shah PS, Shojania K, Wald R, Harel Z. Effectiveness of Quality Improvement Strategies for the Management of CKD: A Meta-Analysis. Clin J Am Soc Nephrol 2017; 12:1601-1614. [PMID: 28877926 PMCID: PMC5628709 DOI: 10.2215/cjn.02490317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/06/2017] [Accepted: 06/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Quality improvement interventions have enhanced care for other chronic illnesses, but their effectiveness for patients with CKD is unknown. We sought to determine the effects of quality improvement strategies on clinical outcomes in adult patients with nondialysis-requiring CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a systematic review of randomized trials, searching Medline and the Cochrane Effective Practice and Organization of Care database from January of 2003 to April of 2015. Eligible studies evaluated one or more of 11 prespecified quality improvement strategies, and prespecified study outcomes included at least one process of care measure, surrogate outcome, or hard clinical outcome. We used a random effects model to estimate the pooled risk ratio (RR; dichotomous data) or the mean difference (continuous data). RESULTS We reviewed 15 patient-level randomized trials (n=3298 patients), and six cluster-randomized trials (n=30,042 patients). Quality improvement strategies reduced dialysis incidence (seven trials; RR, 0.85; 95% confidence interval [95% CI], 0.74 to 0.97) and LDL cholesterol concentrations (four trials; mean difference, -17.6 mg/dl; 95% CI, -28.7 to -6.5), and increased the likelihood that patients received renin-angiotensin-aldosterone system inhibitors (nine trials; RR, 1.16; 95% CI, 1.06 to 1.27). We did not observe statistically significant effects on mortality, cardiovascular events, eGFR, glycated hemoglobin, and systolic or diastolic BP. CONCLUSIONS Quality improvement interventions yielded significant beneficial effects on three elements of CKD care. Estimates of the effectiveness of quality improvement strategies were limited by study number and adherence to quality improvement principles. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_09_06_CJASNPodcast_17_10.mp3.
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Affiliation(s)
- Samuel A. Silver
- Division of Nephrology and
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Chaim M. Bell
- Departments of Medicine and
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; and
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Prakesh S. Shah
- Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Kaveh Shojania
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; and
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ron Wald
- Division of Nephrology and
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ziv Harel
- Division of Nephrology and
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Canada
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Navaneethan SD, Jolly SE, Schold JD, Arrigain S, Nakhoul G, Konig V, Hyland J, Burrucker YK, Dann PD, Tucky BH, Sharp J, Nally JV. Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD. Clin J Am Soc Nephrol 2017; 12:1418-1427. [PMID: 28778854 PMCID: PMC5586570 DOI: 10.2215/cjn.02100217] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 02/22/2017] [Accepted: 05/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: (1) enhanced personal health record only, (2) patient navigator only, (3) both, and (4) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. RESULTS Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups (P=0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. CONCLUSIONS We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators and patient education through an enhanced personal health record in those with CKD.
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Affiliation(s)
- Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Jesse D. Schold
- Department of Quantitative Health Sciences, and
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
| | | | - Georges Nakhoul
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
| | | | - Jennifer Hyland
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Yvette K. Burrucker
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Priscilla Davis Dann
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Barbara H. Tucky
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - John Sharp
- Personal Connected Health Alliance of Healthcare Information and Management Systems Society, Cleveland, Ohio
| | - Joseph V. Nally
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; and
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38
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Akbar MF. Inhibition of indoxyl sulfate-induced intrarenal renin-angiotensin system activation: targeting the aryl hydrocarbon receptor. Transl Clin Pharmacol 2017; 25:114-116. [PMID: 32095460 PMCID: PMC7033375 DOI: 10.12793/tcp.2017.25.3.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/17/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022] Open
Abstract
Indoxyl sulfate, a protein-bound uremic toxin, leads to CKD (chronic kidney disease) progression and its complications through the activation of AhR (aryl hydrocarbon receptor) and RAS (renin-angiotensin system). Inhibition of these pathways may slow the development of CKD and CKD-associated complications.
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Affiliation(s)
- Muhammad Firman Akbar
- Department of General Health Service, Sahabat Sehat Clinic, West Nusa Tenggara, Indonesia, Department of Medicine, University of Melbourne St. Vincent's Hospital Melbourne, Australia
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39
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Lee MJ, Kim SS, Kim IJ, Song SH, Kim EH, Seo JY, Kim JH, Kim S, Jeon YK, Kim BH, Kim YK. Changes in Urinary Angiotensinogen Associated with Deterioration of Kidney Function in Patients with Type 2 Diabetes Mellitus. J Korean Med Sci 2017; 32:782-788. [PMID: 28378551 PMCID: PMC5383610 DOI: 10.3346/jkms.2017.32.5.782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/27/2017] [Indexed: 01/13/2023] Open
Abstract
Urinary angiotensinogen (AGT) is potentially a specific biomarker for the status of the intrarenal renin-angiotensin system (RAS) in patients with diabetes mellitus. We explored whether changes in urinary AGT excretion levels were associated with the deterioration of kidney function in type 2 diabetes patients with preserved kidney function. Urinary baseline AGT levels were measured in 118 type 2 diabetic patients who were not taking RAS blockers and who had estimated glomerular filtration rates (eGFRs) ≥ 60 mL/min/1.73 m². A total of 91 patients were followed-up for 52 months. Changes in urinary levels of AGT (ΔAGT) were calculated by subtracting urinary AGT/creatinine (Cr) at baseline from urinary AGT/Cr after 1 year. ΔAGT was significantly inversely correlated with annual eGFR change (β = -0.29, P = 0.006; β = -0.37, P = 0.001 after adjusting for clinical factors). RAS blockers were prescribed in 36.3% of patients (n = 33) during follow-up. The ΔAGT values were lower in the RAS blockers users than in the non-RAS blockers users, but the differences were not statistically significant (7.37 ± 75.88 vs. 22.55 ± 57.45 μg/g Cr, P = 0.081). The ΔAGT values remained significantly correlated with the annual rate of eGFR change (β = -0.41, P = 0.001) in the patients who did not use RAS blockers, but no such correlation was evident in the patients who did. ΔAGT is inversely correlated with annual changes in eGFR in type 2 diabetes patients with preserved kidney function, particularly in RAS blocker-naïve patients.
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Affiliation(s)
- Min Jin Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Yeong Seo
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jong Ho Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sungsu Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
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Palevsky PM, Zhang JH, Seliger SL, Emanuele N, Fried LF. Incidence, Severity, and Outcomes of AKI Associated with Dual Renin-Angiotensin System Blockade. Clin J Am Soc Nephrol 2016; 11:1944-1953. [PMID: 27679519 PMCID: PMC5108193 DOI: 10.2215/cjn.03470316] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/26/2016] [Accepted: 07/22/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The benefit of dual blockade of the renin-angiotensin system is limited by adverse effects. We performed a secondary analysis of the Veterans Affairs Nephropathy in Diabetes (VA NEPHRON-D) Study to describe the effect of increased intensity of renin-angiotensin system blockade on the incidence, risk factors, and outcomes of AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In the VA NEPHRON-D Study, we randomized 1148 veterans receiving outpatient care with type 2 diabetes mellitus, eGFR of between 30 and 89.9 ml/min per 1.73 m2, and urinary albumin excretion of at least 300 μg/mg creatinine (or a urinary total protein of at least 0.5 mg/mg creatinine) to either combination therapy with losartan and lisinopril or monotherapy with losartan. We identified hospitalized AKI events and their outcomes during a median follow-up of 2.2 years through systematic reporting of serious adverse events. RESULTS The incidence of AKI was 12.2 (95% confidence interval, 10.5 to 14.0) versus 6.7 (95% confidence interval, 5.6 to 8.2) per 100 patient-years in the combination arm versus monotherapy arms (P<0.001). Individuals with AKI were more likely to develop the primary study end point of death, ESRD, or decline in kidney function (hazard ratio, 1.78; 95% confidence interval, 1.34 to 2.26; P<0.001). Patients with AKI in the combination arm had greater recovery of kidney function (75.9% versus 66.3%; P=0.04), lower 30-day mortality (4.7% versus 15.0%; P<0.01), and lower hazard for development of the primary study end point (hazard ratio, 0.60; 95% confidence interval, 0.37 to 0.98). CONCLUSIONS Dual renin-angiotensin system blockade was associated with an increased risk of AKI compared with monotherapy, but AKI in the setting of monotherapy was associated with lower rates of recovery of kidney function, higher mortality, and higher risk of progression of kidney disease.
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Affiliation(s)
- Paul M. Palevsky
- Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jane H. Zhang
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Stephen L. Seliger
- Medical Service, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicholas Emanuele
- Medical Service, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois; and
- Department of Medicine, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - Linda F. Fried
- Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Ferreira de Oliveira F, Berretta JM, Suchi Chen E, Cardoso Smith M, Ferreira Bertolucci PH. Pharmacogenetic effects of angiotensin-converting enzyme inhibitors over age-related urea and creatinine variations in patients with dementia due to Alzheimer disease. Colomb Med (Cali) 2016; 47:76-80. [PMID: 27546928 PMCID: PMC4975126] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Renal function declines according to age and vascular risk factors, whereas few data are available regarding genetically-mediated effects of anti-hypertensives over renal function. OBJECTIVE To estimate urea and creatinine variations in dementia due to Alzheimer disease (AD) by way of a pharmacogenetic analysis of the anti-hypertensive effects of angiotensin-converting enzyme inhibitors (ACEis). METHODS Consecutive outpatients older than 60 years-old with AD and no history of kidney transplant or dialytic therapy were recruited for prospective correlations regarding variations in fasting blood levels of urea and creatinine in one year, considering ACE genotypes of rs1800764 and rs4291 and their respective haplotypes, and treatment with ACEis along with blood pressure variations. RESULTS For 190 patients, 152 had arterial hypertension, and 122 used ACEis. Minor allele frequencies were 0.492 for rs1800764-C and 0.337 for rs4291-T, both in Hardy-Weinberg equilibrium. There were no overall significant yearly variations in levels of urea and creatinine, but their concurrent variations were positively correlated (ρ <0.0001). Each A allele of rs4291 led to an yearly urea increase of 3,074 mg/dL, and an yearly creatinine increase of 0.044 mg/dL, while the use of ACEis was protective regarding creatinine variations. The use of ACEis was also protective for carriers of rs1800764-CT/rs4291-AA, while carriers of rs1800764-CT/rs4291-AT had steeper reductions in creatinine levels, particularly when they were treated with ACEis. CONCLUSIONS Effects of ACEis over creatinine variations are genetically mediated and independent of blood pressure variations in older people with AD.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Juliana Marília Berretta
- Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Won J, Hong YJ, Jeong MH, Park HJ, Kim MC, Kim WJ, Kim HK, Sim DS, Kim JH, Ahn Y, Cho JG, Park JC. Comparative Effects of Statin Therapy versus Renin-Angiotensin System Blocking Therapy in Patients with Ischemic Heart Failure Who Underwent Percutaneous Coronary Intervention. Chonnam Med J 2016; 52:128-35. [PMID: 27231678 PMCID: PMC4880578 DOI: 10.4068/cmj.2016.52.2.128] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
Statins and renin-angiotensin system (RAS) blockers are key drugs for treating patients with an acute myocardial infarction (AMI). This study was designed to show the association between treatment with statins or RAS blockers and clinical outcomes and the efficacy of two drug combination therapies in patients with ischemic heart failure (IHF) who underwent revascularization for an AMI. A total of 804 AMI patients with a left ventricular ejection fraction <40% who undertook percutaneous coronary interventions (PCI) were analyzed using the Korea Acute Myocardial Infarction Registry (KAMIR). They were divided into four groups according to the use of medications [Group I: combination of statin and RAS blocker (n=611), Group II: statin alone (n=112), Group III: RAS blocker alone (n=53), Group IV: neither treatment (n=28)]. The cumulative incidence of major adverse cardiac and cerebrovascular events (MACCEs) and independent predictors of MACCEs were investigated. Over a median follow-up study of nearly 1 year, MACCEs had occurred in 48 patients (7.9%) in Group I, 16 patients (14.3%) in Group II, 3 patients (5.7%) in Group III, 7 patients (21.4%) in Group IV (p=0.013). Groups using RAS blocker (Group I and III) showed better clinical outcomes compared with the other groups. By multivariate analysis, use of RAS blockers was the most powerful independent predictor of MACCEs in patients with IHF who underwent PCI (odds ratio 0.469, 95% confidence interval 0.285-0.772; p=0.003), but statin therapy was not found to be an independent predictor. The use of RAS blockers, but not statins, was associated with better clinical outcomes in patients with IHF who underwent PCI.
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Affiliation(s)
- Jumin Won
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Hyuk Jin Park
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Min Chul Kim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Woo Jin Kim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Doo Sun Sim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Ju Han Kim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Jeong Gwan Cho
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Jong Chun Park
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
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Abstract
Accumulating evidence has demonstrated that hydrogen sulfide (H2S) plays critical roles in the pathogenesis of chronic kidney diseases. This study was designed to investigate whether H2S has protective effects against diabetic nephropathy. Diabetic rats were induced by intraperitoneal injection of streptozotocin and administrated with H2S donor NaHS for 12 weeks. Rat glomerular mesangial cells were pretreated with NaHS or MAPK inhibitors (U0126, SP600125, and SB203580) prior to high glucose exposure, and cell proliferation was determined. Our findings suggest that H2S can improve renal function and attenuate glomerular basement membrane thickening, mesangial matrix deposition, and renal interstitial fibrosis in diabetic rats. H2S was found to reduce high glucose-induced oxidative stress by activating the Nrf2 antioxidant pathway and to exert anti-inflammatory effects by inhibiting NF-κB signaling. In addition, H2S reduced high glucose-induced mesangial cell proliferation by blockade of MAPK signaling pathways. Moreover, H2S was also found to inhibit the renin-angiotensin system in diabetic kidney. In conclusion, our study demonstrates that H2S alleviates the development of diabetic nephropathy by attenuating oxidative stress and inflammation, reducing mesangial cell proliferation, and inhibiting renin-angiotensin system activity.
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Affiliation(s)
| | | | - Zhoubing Zhan
- Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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Rubio-Ruíz ME, Del Valle-Mondragón L, Castrejón-Tellez V, Carreón-Torres E, Díaz-Díaz E, Guarner-Lans V. Angiotensin II and 1-7 during aging in Metabolic Syndrome rats. Expression of AT1, AT2 and Mas receptors in abdominal white adipose tissue. Peptides 2014; 57:101-8. [PMID: 24819472 DOI: 10.1016/j.peptides.2014.04.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
Abstract
Renin-Angiotensin System (RAS) plays an important role in the development of Metabolic Syndrome (MS) and in aging. Angiotensin 1-7 (Ang 1-7) has opposite effects to Ang II. All of the components of RAS are expressed locally in adipose tissue and there is over-activation of adipose RAS in obesity and hypertension. We determined serum and abdominal adipose tissue Ang II and Ang 1-7 in control and MS rats during aging and the expression of AT1, AT2 and Mas in white adipose tissue. MS was induced by sucrose ingestion during 6, 12 and 18 months. During aging, an increase in body weight, abdominal fat and dyslipidemia were found but increases in aging MS rats were higher. Control and MS concentrations of serum Ang II from 6-month old rats were similar. Aging did not modify Ang II seric concentration in control rats but decreased it in MS rats. Ang II levels increased in WAT from both groups of rats. Serum and adipose tissue Ang 1-7 increased during aging in MS rats. Western blot analysis revealed that AT1 expression increased in the control group during aging while AT2 and Mas remained unchanged. In MS rats, AT1 and AT2 expression decreased significantly in aged rats. The high concentration of Ang 1-7 and adiponectin in old MS rats might be associated to an increased expression of PPAR-γ. PPAR-γ was increased in adipose tissue from MS rats. It decreased with aging in control rats and showed no changes during aging in MS rats. Ang 1-7/Mas axis was the predominant pathway in WAT from old MS animals and could represent a potential target for therapeutical strategies in the treatment of MS during aging.
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Affiliation(s)
- M E Rubio-Ruíz
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico D.F., Mexico
| | - L Del Valle-Mondragón
- Department of Pharmacology, Instituto Nacional de Cardiología ``Ignacio Chávez'' Mexico D.F., Mexico
| | - V Castrejón-Tellez
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico D.F., Mexico
| | - E Carreón-Torres
- Department of Molecular Biology, Instituto Nacional de Cardiología ``Ignacio Chávez'' Mexico D.F., Mexico
| | - E Díaz-Díaz
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Mexico D.F., Mexico
| | - V Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico D.F., Mexico.
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Morishita Y, Kusano E. Direct Renin inhibitor: aliskiren in chronic kidney disease. Nephrourol Mon 2012; 5:668-72. [PMID: 23577328 PMCID: PMC3614331 DOI: 10.5812/numonthly.3679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 12/12/2011] [Accepted: 12/18/2011] [Indexed: 02/07/2023] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of chronic kidney disease (CKD) progression and its increased complications such as hypertension (HT) and cardiovascular diseases (CVD). Previous studies suggested that aliskiren a direct renin inhibitor, blocks RAAS and may be effective for the management of CKD and its complications. This review focuses on the effects of aliskiren on CKD.
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Affiliation(s)
- Yoshiyuki Morishita
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
- Corresponding author: Yoshiyuki Morishita, Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, 329-0498, Tochigi, Japan. Tel.: + 81-285447346, Fax: +81-285444869, E-mail:
| | - Eiji Kusano
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Yoon SP. Insights into the possible mechanism of cyclosporine-induced chronic nephrotoxicity; arteriolopathy. Nephrourol Mon 2012; 4:489-90. [PMID: 23573475 PMCID: PMC3614264 DOI: 10.5812/numonthly.2689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 10/19/2011] [Accepted: 10/23/2011] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sang Pil Yoon
- Department of Anatomy, School of Medicine, Jeju National University, Jeju-Do, Republic of Korea
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