Advances in Medical Treatment of Primary Aldosteronism / 中国医学科学杂志(英文版)

Primary aldosteronism (PA) is the most common form of secondary hypertension, with its main manifestations including hypertension and hypokalemia. Early identification of PA is extremely important as PA patients can easily develop cardiovascular complications such as atrial fibrillation, stroke, and myocardial infarction. The past decade has witnessed the rapid advances in the genetics of PA, which has shed new light on PA treatment. While surgery is the first choice for unilateral diseases, bilateral lesions can be treated with mineralocorticoid receptor antagonists (MRAs). The next-generation non-steroidal MRAs are under investigations. New medications including calcium channel blockers, macrophage antibiotics, and aldosterone synthase inhibitors have provided a new perspective for the medical treatment of PA.

Effect of wheat-grain moxibustion on the expression of 5-HT and cortisol in the serum, and MR and GR in the hippocampus in rats with hypothyroidism complicated with depression / 中国针灸

OBJECTIVE@#To observe the effect of wheat-grain moxibustion on behavior, 5-hydroxytryptamine (5-HT) and cortisol in the serum, mineralocorticoid receptor (MR) and glucocorticoid receptor (GR) in the hippocampus in rats with hypothyroidism complicated with depression, and to explore the possible mechanism of wheat-grain moxibustion on improving depression in rats with hypothyroidism.@*METHODS@#A total of 32 SPF SD rats were randomly divided into a blank group, a model group, a medication group and a wheat-grain moxibustion group, 8 rats in each group. Except for the blank group, the rats in the remaining groups were treated with intragastric administration of 0.1% propylthiouracil (PTU) suspension at 1 mL/100 g, once a day for 4 weeks to establish the rat model of hypothyroidism, and whether the rats were accompanied with depression-like behavior determined through behavioristics evaluation. The rats in the medication group were intervened with euthyrox at 0.9 mL/100 g, once a day, for 4 weeks; the rats in the wheat-grain moxibustion group were treated with wheat-grain moxibustion at "Dazhui" (GV 14), "Mingmen" (GV 4), "Shenshu" (BL 23) and "Pishu" (BL 20), 7 cones each acupoint, once a day, six times a week for 4 weeks. After the intervention, the depression status was observed by behavioristics test; the contents of thyroid stimulating hormone (TSH), total thyroxine (TT4), 5-HT and cortisol in the serum were detected by ELISA; the protein expressions of MR and GR in hippocampus were detected by Western blot; the expressions of MR mRNA and GR mRNA in the hippocampus were detected by real-time PCR.@*RESULTS@#Before the intervention, compared with the blank group, the scores of open field test (OFT) were decreased and the immobility time of tail suspension test (TST) was prolonged (P<0.05); the serum TSH contents were increased and TT4 contents were decreased (P<0.01) in the other three groups. After the intervention, compared with the model group, the vertical score of OFT was increased and the immobility time of forced swimming test (FST) was prolonged in the medication group (P<0.05), while the scores of three items of OFT were increased (P<0.05, P<0.01), and the immobility time of FST and TST was shortened in the wheat-grain moxibustion group (P<0.01, P<0.05). Compared with the medication group, the immobility time of TST and FST in the wheat-grain moxibustion group was shorter (P<0.05, P<0.01). Compared with the blank group, in the model group, the contents of serum TSH and cortisol were increased (P<0.01, P<0.001), while the contents of serum TT4 and 5-HT were decreased (P<0.01, P<0.001). Compared with the model group, the contents of serum TT4 and 5-HT were increased, while the contents of serum TSH and cortisol were decreased in the medication group and wheat-grain moxibustion group (P<0.01, P<0.05). Compared with the blank group, the protein and mRNA expression of MR, GR in the hippocampus in the model group was decreased (P<0.01, P<0.05, P<0.001); compared with the model group, the protein and mRNA expression of MR in the hippocampus in the medication group were increased (P<0.05), and the protein expression of MR, GR and mRNA expression of MR in the hippocampus in the wheat-grain moxibustion group were increased (P<0.05, P<0.01). Compared with the medication group, the expression of MR mRNA in the wheat-grain moxibustion group was increased (P<0.05).@*CONCLUSION@#Wheat-grain moxibustion could significantly improve thyroid function and depression in rats with hypothyroidism. Its mechanism may be related to up-regulating the protein and mRNA expression of MR and GR in the hippocampus, and then affecting the expression of serum cortisol and 5-HT.

Effect of Sinisan on BDNF/TrkB， 5-HT/5-HT1AR， and HPA axis in Depression Model Rats / 中国实验方剂学杂志

Objective:To observe the effect of Sinisan on the brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TrKB）， 5-hydroxytryptamine （5-HT）/5-HT1A receptor （5-HT1AR）， and hypothalamus-pituitary-adrenal （HPA） axis in depressed rats， and explore the antidepressant mechanism of Sinisan based on BDNF/TrKB， 5-HT/5-HT1AR， and HPA axis. Method:A total of 120 male Wistar rats were randomly divided into a normal group， a model group， a fluoxetine （0.01 g·kg^-1） group， and low- （1.25 g·kg^-1）， medium- （2.5 g·kg^-1）， and high-dose （5 g·kg^-1） Sinisan groups， with 20 rats in each group. The depression model was induced by isolation combined with chronic unpredictable mild stimulation（CUMS） in rats except for those in the normal group for 21 days. Rats were then treated correspondingly once a day for 21 days by gavage. Those in the normal group and the model group received an equal volume of normal saline. During the intervention， the model rats were stimulated continuously. The depressive state of CUMS model rats was evaluated by sucrose preference test and open field test. Enzyme-linked immunosorbent assay （ELISA） was used to determine the levels of corticotropin-releasing hormone （CRH）， adrenocorticotropic hormone （ACTH）， and corticosterone （CORT） in the plasma and BDNF and 5-HT levels in the hippocampal homogenate. The mRNA expression of hippocampal TrKB， 5-HT1AR， glucocorticoid receptor （GR）， and mineralocorticoid receptor （MR） was detected by real-time fluorescence-based quantitative polymerase chain reaction （Real-time PCR）. The protein expression of hippocampal TrKB， 5-HT1AR， GR， and MR was detected by Western blot. The histomorphological changes of the hippocampus were observed by hematoxylin-eosin （HE） staining. Result:Compared with the normal group， the model group showed decreased sucrose preference rate （<italic>P</italic><0.01）， reduced horizontal and vertical scores in the open field test （<italic>P</italic><0.01）， increased plasma content of CRH， ACTH， and CORT （<italic>P</italic><0.01）， declining content of BDNF and 5-HT in the hippocampus （<italic>P</italic><0.01）， dwindled mRNA and protein expression levels of TrKB， 5-HT1AR， and GR （<italic>P</italic><0.01）， elevated mRNA and protein expression of MR （<italic>P</italic><0.01）， and damaged hippocampal neurons revealed by HE staining. Compared with the model group， the groups with drug intervention showed increased sucrose preference rate （<italic>P</italic><0.01） and horizontal and vertical scores in the open field test （<italic>P</italic><0.05， <italic>P</italic><0.01）， decreased content of plasma CRH， ACTH， and CORT （<italic>P</italic><0.05， <italic>P</italic><0.01）， elevated content of hippocampal BDNF and 5-HT （<italic>P</italic><0.05， <italic>P</italic><0.01）， elevated mRNA and protein expression levels of hippocampal TrKB， 5-HT1AR， and GR （<italic>P</italic><0.05， <italic>P</italic><0.01）， reduced mRNA and protein expression levels of hippocampal MR （<italic>P</italic><0.05， <italic>P</italic><0.01）， and recovered hippocampal neurons as revealed by HE staining. Conclusion:Sinisan can exert a significant antidepressant effect by increasing hippocampal BDNF and 5-HT content， up-regulating TrKB， 5-HT1AR， and GR mRNA and protein expression， down-regulating MR mRNA and protein expression， inhibiting HPA axis hypertrophy， and enhancing the regeneration and repair of hippocampal neurons.

Diabetes mellitus e insuficiencia cardíaca: nuevas perspectivas en el tratamiento farmacológico / Diabetes and heart failure: new perspectives in pharmacological treatment

La Diabetes Mellitus (DM) y la Insuficiencia Cardíaca (IC) son enfermedades crónicas cuyas prevalencias han ido en aumento y que determinan una mayor mortalidad de los pacientes que las padecen. La relación de ambas enfermedades es conocida como "Miocardiopatía Diabética" (MD). Los eventos fisiopatológicos principales de la MD son el mal control glicémico, el aumento de captación de ácidos grasos por parte de las células cardiacas, la disfunción endotelial y la remodelación cardíaca. Los nuevos tratamientos, se han enfocado en tratar tanto el control glicémico como la remodelación cardíaca. Los principales exponentes de los fármacos antidiabéticos favorables para la IC en pacientes con DM son los inhibidores del cotransportador de Sodio-Glucosa renal SGLT2 (iSGLT2), y los agonistas del receptor de GLP-1 (aGLP-1). Otros fármacos de relevancia son los antagonistas del receptor de mineralocorticoides (aRMC). Se realiza una revisión de la fisiopatología y del manejo actualizado de la IC en pacientes con DM.

Diabetes Mellitus (DM) and Heart Failure (HF) are chronic diseases whose prevalences have risen and which increase patient mortality. The two diseases are inter-related in what is called "Diabetic Cardiomyopathy" (DC). The main pathophysiological characteristics of cardiomyopathy are poor glycemic control, a rise in the capture of fatty acids by cardiac cells, endothelial dysfunction and cardiac remodeling. The principal anti-diabetic medications beneficial for HF in DM patients are renal sodium-glucose cotransporter-2 inhibitors (SGLT2) and GLP-1 receptor agonists (GLP-1RAs). Other relevant medications are mineralocorticoid receptor antagonists (MRA). We review the pathophysiology and current management of HF in diabetic patients.

Antagonistas de mineralocorticoides en coriorretinopatía central serosa crónica / Mineralocorticoid receptor antagonists in chronic central serous chorioretinopathy

INTRODUCCIÓN: La coriorretinopatía central serosa consiste en la filtración de fluido desde la coroides y su acumulación en el espacio subretinal. Su forma crónica se asocia a pérdida visual permanente. Los antagonistas de mineralocorticoides son una alternativa de tratamiento para esta patología, aunque no existe evidencia clara sobre su efectividad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron 22 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de antagonistas de mineralocorticoides en coriorretinopatía central serosa crónica probablemente resulta en poca o nula diferencia en la agudeza visual corregida. No es posible establecer con claridad si su uso disminuye el grosor del fluido subretinal, debido a que la certeza de la evidencia ha sido evaluada como muy baja. Además, esta intervención podría resultar en poca o nula diferencia en la aparición de efectos adversos, pero la certeza de la evidencia es baja.

INTRODUCTION: Central serous chorioretinopathy consists of the leakage of fluid from the choroid and its accumulation into the subretinal space. Its chronic form is associated with permanent vision loss. Mineralocorticoid receptor antagonists are an alternative treatment for this condition, although there is no clear evidence about their effectiveness. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including 22 studies overall and four of them are randomized trials. We concluded that in chronic central serous chorioretinopathy, mineralocorticoid receptor antagonists probably make little or no difference to best-corrected visual acuity. We are uncertain whether this intervention reduces subretinal fluid height because the certainty of the evidence is very low. Furthermore, this intervention may make little or no difference in terms of adverse effects, but the certainty of the evidence is low.

Inhibition of mineralocorticoid receptor activation by eplerenone to reduce autophagy in obstructive nephropathy / 中国药理学通报

Aim To observe the effect of mineralocorticoid receptor blocker eplerenone on autophagy in obstructive nephropathy and its mechanism. Methods Totally 36 male Wistar rats were randomly divided into sham-operation group, model group and eplerenone group. The animal models were established with unilarteral urteral obstruction ( UUO). The rats in eplerenone group were treated with eplerenone (100 mg • kg"1 • d"1). The obstructed kidneys were collected lOd after UUO. The expression of NR3C2 was detected by laser confocal microscopy, the expression of serum and glucocorticoid-induced protein kinase 1 ( SGK-1), phosphorylated mammal target of rapamycin (p-mTOR) , autophagy associated gene 5 (Atg5) , Be-clin-1 and microtubular-associated protein 1 light chain 3 (LC3) were detected by immunohistochemistry and Western blot. Results The expression of NR3C2 was detected in cytoplasm of renal tubular distal epithelial cells, but not in nucleus in sham-operation group with laser confocal microscopy. The expression of NR3C2 was enhanced significantly in model group, mainly in nucleus but significantly inhibited in eplerenone group. The immunohistochemistry and Western blot showed that the expressions of SGK-1, Atg5, Beclin-1 and the ratio of LC3 11/I in model group were up-regulated and down-regulated by eplerenone treated group. The expression of p-mTOR was down-regulated in model group compared with sham-operation group and up-regulated in eplerenone group. Conclusions Eplerenone plays a role in reducing autophagy in obstructive nephropathy via inhibiting the activation of mineralocorti-coid receptor.

Estudio e identificación de microRNA en exosomas urinarios en hipertensión arterial mineralocorticoide / Study and identification of microRNA in urinary exosomes in mineralocorticoid arterial hypertension

About 15% of the essential hypertensive patients would have a low activity of the 11ßHSD2 enzyme, which inactivates cortisol (F) to cortisone (E). Gene expression can be negatively regulated by miRNA. Urinary exosomes and their specific content (miRNA/proteins) represent a valuable tool as a biomarker for the diagnosis and prognosis of the disease. Aim: To evaluate the expression of miRNA specific for 11ßHSD2 in samples of urinary exosomes and to determine its association with biochemical variables associated with mineralocorticoid metabolism. Subjects and Methods: Cross-sectional study in subjects between 10-60 years. They were classified into subjects with high F/E (> p75) and low cortisone (< p25) and control subjects. The urinary exosomes were isolated with the Invitrogen kit. Bioinformatic analysis was performed with Mir Walk to identify specific miRNAs of HSD11B2. The expression of miRNA was evaluated by qRT PCR. The comparisons were made with the Mann-Whitney test. Results: 7.1% of the subjects are suggestive of a partial deficiency of 11ßHSD2 (NC-AME). The expression of miR-488 was higher in NC-AME than in controls (5839 ± 1719 vs 3,437 ± 2,581; p = 0.01). We found positive associations between mir-615 and ARP; miR-488 and the sodium/potassium ratio; miR-1205 with age and urinary sodium excretion; miR-494 with age, activity MMP9 and NGAL. Conclusion: We identified high expression of miR488 in NC-AME subjects and associations of miRNAs with biochemical variables associated with mineralocorticoid metabolism. Thus, exosomes and their miRNA content could be potential regulators and biomarkers of 11ßHSD2 activity.

Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis

BACKGROUND: Previous studies have shown that aldosterone antagonists have a proteinuria-lowering effect in patients with proteinuria and progressive proteinuric disease not adequately controlled by the use of angiotensin receptor blockers (ARBs). Aldosterone antagonists, in combination with ARBs, might improve proteinuria in patients with glomerulonephritis (GN). METHODS: In the present retrospective study, we evaluated the proteinuria-lowering effect and drug safety of low-dose spironolactone (12.5 mg/day) in 42 patients with GN being treated with an ARB. RESULTS: Proteinuria decreased from a mean total-protein-to-creatinine (TP/Cr) ratio of 592.3 ± 42.0 mg/g at baseline to 335.6 ± 43.3 mg/g after three months of treatment with spironolactone (P < 0.001). After the initial three months, the mean TP/Cr ratio increased progressively at six, nine, and 12 months; however, it was still less than the baseline value (P = 0.001, < 0.001, and < 0.001, respectively). Although serum Cr levels increased significantly at three and nine months compared with baseline (P = 0.036 and 0.026, respectively), there was no time effect of treatment (P = 0.071). Serum potassium levels tended to increase with time (P = 0.118), whereas systolic and diastolic blood pressures decreased with time (P = 0.122 and 0.044, respectively). CONCLUSION: Low-dose spironolactone in combination with an ARB reduced proteinuria in patients with GN, which could represent a novel treatment option in individuals whose proteinuria is not optimally controlled by the use of ARBs alone.

Mechanism of Shenluotong regulating NR3C2/SGK-1/Smad pathway in inhibiting renal interstitial fibrosis / 中草药

Objective To investigate the mechanism of Shenluotong inhibiting renal interstitial fibrosis by regulating NR3C2/SGK-1/Smad pathway. Methods A total of 48 Wistar rats were randomly divided into sham operation group, model group, Eplerenone group, and Shenluotong group (n = 12). Model group, Eplerenone group, and Shenluotong group used unilateral ureteral obstruction (UUO) method to establish rat renal interstitial fibrosis model. After the operation, the rats in the eplerenone group were treated with eplerenone at a dose of 100 mg/(kg∙d). Rats in the Shenluotong group were oral given Shenluotong decoction at a dose of 26 g/(kg∙d) and Sham operation group and model group were administrated equal volume of saline once daily for continuous 10 d. Laser confocal microscopy was used to detect mineralocorticoid receptor NR3C2 expression. The expressions of SGK-1, TGF-β1, Smad4, and Smad7 in renal tissues were detected by immunohistochemistry, Western Blot and Real time-PCR. Results In the sham operation group, NR3C2 was expressed in the cytoplasm of renal tubular epithelial cells and was not expressed in the nucleus. The expression of NR3C2 in the UUO rat was significantly up-regulated in cytoplasm and positive expression was observed in the nucleus. The expression of NR3C2 in the nucleus of cells in the Eplerenone group and Shenluotong group was significantly decreased when compared with the model group. Compared with the sham-operated group, the expression of SGK-1, TGF-β1, and Smad4 was significantly up-regulated and the expression of Smad7 was significantly decreased (P < 0.05, 0.01) in the other groups. Compared with model group, the expression range and intensity of TGF-β1 and Smad4 were significantly decreased in Eplerenone group and Shenluotong group (P < 0.05, 0.01), and the expression range and intensity of Smad7 were significantly increased (P < 0.01). Conclusion Shenluotong can inhibit renal interstitial fibrosis through blocking the activation of mineralocorticoid receptor, reducing the level of SGK-1, and regulating the Smads signal pathway to inhibit the overexpression of TGF-β1.

Aldosterona e IL-17 en la génesis de la hipertensión arterial mineralocorticoídea, un estudio ex vivo / Aldosterone and il-17 in the genesis of mineralocorticoid arterial hypertension: an ex vivo study

Background: Treatment of dendritic cells (DC) with aldosterone induces the secretion of IL-6 and TGF-beta. The polarization of naïve T cells to helper 17 T lymphocytes with DCs pre-incubated with aldosterone, has been described in vivo, generating an IL-17 hyper-secreting phenotype, a cytokine associated with cardiac and renal fibrosis. There are mineralocorticoid receptors (MR) in immune cells and their activation may determine the inflammatory (M1) or adaptive (M2) macrophage phenotype. Aldosterone levels could regulate immunogenic gene expression in these cells, modulating the liberation of specific cytokines. Aim: To assess in humans the association of aldosterone levels and IL-17 with inflammatory markers in peripheral blood mononuclear cells (PBMC). Material and Methods: In blood samples of 176 participants aged 18 to 67 years (61 percent women) with a body mass index of 27.1 +/- 4.8 kg/m2, aldosterone, plasma renin activity (ARP), cortisol, C reactive protein, andIL-17 were measured. mRNA was isolated from PBMCs to measure the expression of MR RAC-1, HO-1, TLR-4, CD-14, NGAL and IL-17 by real time polymerase chain reaction. Results: Aldosterone correlated positively with ARP and the expression of CD-14 in PBMCs. Plasma levels of IL-17 were positively associated with the expression of MR, Rac1a and NGAL. Conclusions: Aldosterone and IL-17 levels were associated with inflammatory activation markers in PBMC, which could activate MRand promote a subclinical inflammatory status inducing hypertension.

Effect of lipopolysaccharide-mediated infection during pregnancy on the expression of mineralocorticoid receptor and dendritic spines in hippocampus of rat offspring / 中华实用儿科临床杂志

Objective To observe the effect of lipopolysaccharide (LPS)-mediated infection during pregnancy on the expression of mineralocorticoid receptor (MR) and density of dendritic spines in CA1 region of the dorsal hippocampus of rat offspring,so as to explore the mechanisms for learning and memory injury of rat offspring which were infected during prenatal period,then to provide scientific experimental evidence for the prevention of prenatal infection-induced delayed neuropsychiatric sequelae which contributed to learning and memory dysfunction.Methods Ten-week-old female Sprague-Dawley rats (n =30) were matched with male rats (1 ∶ 1).Pregnant rats were randomly divided into a control group (n =10) and an experimental group (n =20).The pregnant rats in experimental group were treated with LPS (66 μg/kg,intraperitoneally),and the pregnant rats in control group were intraperitoneally injected with same volume of saline on gestational day 10.On postnatal day 48,Morris water maze was used to estimate the ability of learning and memory;the brain tissues of offspring were taken and paraffin sections were stained with hematoxylin eosin (HE) for histological observation of CA1 region of the dorsal hippocampus;frozen sections were treated with indirect immunofluorescence to observe the expression of MR in CA1 region of the dorsal hippocampus;Golgi-Cox method was used to observe the density of dendritic spines of CA1 region.Results In Morris water maze test,from the third day the time of escape latency in experimental group [the 3rd day:(42.603 ± 9.837) s;the 4th day:(30.222 ± 9.789) s;the 5th day:(28.808 ± 12.526) s] was significantly higher than that of the control group [the 3rd day:(28.078±14.088) s;the 4th day:(20.692±13.099) s;the 5th day:(14.632 ±11.624) s] (the 3rd day:t =-3.274,P＜0.01;the 4th day:t =-2.257,P ＜0.05;the 5th day:t =-3.213,P＜0.01);the swimming time in the target quadrant [(14.660 ± 7.337) times] and the number of crossing platform [(0.933 ± 0.704) times] in experi mental group were significantly decreased compared with those of the control group [time:(23.820 ± 6.321) s;num bers:(2.000 ± 0.756) times] (t =3.663,4.000,all P ＜ 0.01).Hematoxylin eosin staining showed that the nerve cells of the hippocampus in the control group distributed in order,nucleuses were round or oval,nucleoli were obvious,and chromatins were homogeneous;but the cells in the experimental group distributed in disorder and pathological changes were detected,such as cellular swelling,necrosis and obvious nuclear pyknosis.By immunofluorescence staining,the average optical density (AOD) of MR in CA1 region decreased significantly in the experimental group (0.067 ± 0.017) compared with that of the control group (0.083 ± 0.009) (t =2.644,P ＜ 0.05).In Golgi-Cox method,the density of dendritic spines in experimental group [(7.705 ± 0.791)/10 μm] was below that of the control group [(9.655 ± 1.391)/10 μm] (t =3.852,P ＜ 0.01).Conclusions LPS-mediated infection during pregnancy might lead to hippocampus-dependent learning and memory dysfunction which might be associated with the reduced expression of MR and the low density of dendritic spines in CA1 region of the dorsal hippocampus.

Effects of eplerenone on expression and activity of aortic endothelial nitric oxide synthase in hypertensive rats induced by high-salt intake / 中国病理生理杂志

[ ABSTRACT] AIM:To explore the effects of eplerenone on the expression and activity of aortic endothelial nitric oxide synthase ( eNOS) in high salt-induced hypertensive rats .METHODS: Male Wistar rats (4 week old, weighting 50~60 g) were randomly divided into control group , high-salt diet group and eplerenone group .The rats in control group were fed with ordinary rodent animal diet , the rats in high-salt group and eplerenone group were exposed to 5%salt diet for 16 weeks and administrated with the same dosage of saline or eplerenone (40 mg? kg-1? d-1 ) by gavage for 4 weeks, re-spectively.Systolic blood pressure (SBP) was measured by tail-cuff every 2 weeks.The rats were sacrificed after 16 weeks and the thoracic aorta was collected .The aldosterone content in the aorta was measured by ELISA .The protein levels of mineralocorticoid receptor (MR) and eNOS were determined by Western blot.The activitie of constitutive NOS (cNOS) was measured by chemocolorimetry .The protein localization of eNOS , neuronal nitric oxide synthase ( nNOS) and MR was observed by immunohistochemistry .RESULTS: A process of 8-week high-salt diet increased SBP gradually .SBP in the rats exposure to high salt for 16 weeks was significantly higher than that in control group ( P<0.05 ) .After 4 weeks of eplerenone treatment, SBP in the rats was significantly lower than that before treatment (P<0.05).Compared with control group, the aldosterone content in the aorta were significantly increased in high-salt diet group and eplerenone group ( P<0.05), the expression level of MR also increased significantly (P<0.05).Compared with control group, both eNOS pro-tein expression (P<0.05) and cNOS activity in high-salt diet group were significantly decreased (P<0.05).The protein expression of eNOS as well as cNOS activity in aorta increased significantly in eplerenone group compared with high -salt diet group (P<0.05).CONCLUSION:Aldosterone content in aorta of high-salt-induced hypertensive rats increases signifi-cantly .Aldosterone attenuates the protein expression of eNOS and reduces the enzyme activity through the activation of min -eralocorticoid receptor .The selective mineralocorticoid receptor antagonist eplerenone enhances the protein expression of eNOS and its activity , thereby improves eNOS function .

Uso de antagonistas de aldosterona para detener la progresión de la enfermedad renal: de las bases fisiológicas a la aplicación clínica / Clinical use of aldosterone antagonists for slowing progression of chronic kidney disease: From the physiological basis to clinical application

La aldosterona, sintetizada en la zona glomerulosa de la corteza suprarrenal, es la principal hormona reguladora del metabolismo de sodio y potasio y del volumen extracelular. A través del receptor de mineralocorticoides, actúa como la señal endocrina final del sistema renina-angiotensina-aldosterona sobre el epitelio del túbulo renal y del colon distal, que estimula la reabsorción de sodio y la secreción de potasio. El agua se reabsorbe, vía ósmosis, favoreciendo la expansión del volumen circulante y, por ende, incrementando la presión arterial. Recientemente, se ha centrado el interés en las acciones no clásicas de la aldosterona sobre el endotelio vascular, corazón y riñón. Existe evidencia de que la aldosterona está involucrada en la remodelación vascular, la función endotelial y la formación de colágena, y que contribuye a la progresión de la insuficiencia cardiaca, así como del daño renal. Se revisa la evidencia clínica y experimental que fundamenta el uso de bloqueadores de aldosterona para detener la progresión del daño renal en diferentes modelos.

Aldosterone is synthesized in the adrenal cortex and is the main regulator of sodium and potassium metabolism and the extracellular volume. Acting through the mineralocorticoid receptor, it is the final endocrine signal of the renin-angiotensin-aldosterone system with effects on the renal tubular epithelium and distal colon stimulating sodium reabsorption and potassium secretion. Water is absorbed by osmosis favoring expansion of circulating volume and increasing arterial blood pressure. Recently there has been great interest in the non-classical actions of aldosterone on the vascular endothelium, heart and kidney. There is evidence suggesting that aldosterone participates in vascular remodeling, endothelial function and collagen deposition, contributing to heart failure progression and kidney damage. Clinical and experimental evidence supporting the use of aldosterone blocking agents in different models of kidney damage is reviewed.

Aplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovasculares / Mineralocorticoid receptor antagonists and therapeutic strategies of cardiovascular damage

In recent years, much attention has focused on the role of aldosterone and mineralocorticoid receptors (MRs) in the pathophysiology of hypertension and cardiovascular disease. Patients with primary aldosteronism, in whom angiotensin II levels are low, have a higher incidence of cardiovascular complications than patients with essential hypertension. The Randomized Aldactone Evaluation Study (RALES) demonstrated that adding a non-specific MR antagonist, spironolactone, to a standard therapy that included angiotensin-converting enzyme (ACE) inhibitors, loop diuretics, and digoxin, significantly reduced morbidity and mortality in patients with moderate to severe heart failure. Similarly, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) showed that the addition of a selective MR antagonist (ARM), eplerenone, to an optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. These data suggest that aldosterone induces cardiac injury through activation of MRs and support the notion that MR blockade has beneficial effects on aldosterone-dependent cardiac injury, through mechanisms that cannot be simply explained by hemodynamic changes. Although, MRA are highly effective in patients with heart failure, the risk of hyperkalemia should not be overlooked. Serious hyperkalemia events were reported in some MRA clinical trials; however these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up.

Possible Contribution of Mineralocorticoid Receptor Activation on Glucocorticoid-Induced Left Ventricular Remodeling in Adrenalectomized Rat.

Background: Chronic glucocorticoid treatment induces the development of renal injury via mineralocorticoid receptor (MR) activation in bilaterally adrenalectomized rats. It has been hypothesized that glucocorticoid contributes to the development of left ventricular (LV) remodeling through MR activation in bilaterally adrenalectomized rats (ADX).Methods: ADX rats were maintained with 1%NaCl in drinking water and randomly treated as follows for 8 weeks: vehicle (n=7), bilateral adrenalectomy (ADX) + hydrocortisone (HYDRO) (5 mg/kg/day, subcutaneous, n=7), and ADX + HYDRO + eplerenone (0.125% in chow; approximately 75 mg/kg/day, n=7). An osmotic minipump was implanted subcutaneously for continuous infusion of HYDRO. Results: As compared with control vehicletreated uninephrectomized rats, ADX+HYDRO treatment for 8 weeks significantly increased systolic blood pressure, LV weight, collagen content and mRNA levels of atrial natriuretic peptide, brain natriuretic peptide, and collagen type 1 and III. These changes were associated with increase in LV thiobarbituric acid reactive substances content, dihydroethidium fluorescence and mRNA levels of NADPH oxidase subunits. Treatment with a selective MR antagonist, eplerenone significantly attenuated HYDRO induced changes in LV parameters. HYDRO-induced increases in mRNA and protein levels of serum and glucocorticoid-regulated kinases 1 were prevented by eplerenone. Conclusion: These data suggest that chronic glucocorticoid treatment induces LV tissue remodeling through MR dependent mechanism in bilateral adrenalectomized rats.

Pseudohypoaldosteronism Type 1

Pseudohypoaldosteronism (PHA), a rare syndrome of systemic or renal mineralocorticoid resistance, is clinically characterized by hyperkalemia, metabolic acidosis, and elevated plasma aldosterone levels with either renal salt wasting or hypertension. PHA is a heterogeneous disorder both clinically and genetically and can be divided into three subgroups; PHA type 1 (PHA1), type 2 (PHA2) and type 3 (PHA3). PHA1 and PHA2 are genetic disorders, and PHA3 is a secondary disease of transient mineralocorticoid resistance mostly associated with urinary tract infections and obstructive uropathies. PHA1 includes two different forms with different severity of the disease and phenotype: a systemic type of disease with autosomal recessive inheritance (caused by mutations of the amiloride-sensitive epithelial sodium channel, ENaC) and a renal form with autosomal dominant inheritance (caused by mutations of the mineralocorticoid receptor, MR). In the kidneys, the distal nephron takes charge of the fine regulation of water absorption and ion handling under the control of aldosterone. Two major intracellular actors necessary for the action of aldosterone are the MR and the ENaC. Impairment of the intracellular aldosterone signal transduction pathway results in resistance to the action of mineralocorticoids, which leads to PHA. Herein, ion handling the distal nephron and the clinico-genetic findings of PHA are reviewed with special emphasis on PHA type 1.

Effect of aldosterone on the amplification of oncolytic vaccinia virus in human cancer lines / 대한간학회지

BACKGROUND/AIMS: JX-594 is an oncolytic virus derived from the Wyeth vaccinia strain that causes replication-dependent cytolysis and antitumor immunity. Starting with a cross-examination of clinical-trial samples from advanced hepatocellular carcinoma patients having high levels of aldosterone and virus amplification in JX-594 treatment, we investigated the association between virus amplification and aldosterone in human cancer cell lines. METHODS: Cell proliferation was determined by a cell-counting-kit-based colorimetric assay, and vaccinia virus quantitation was performed by quantitative polymerase chain reaction (qPCR) and a viral plaque assay. Also, the intracellular pH was measured using a pH-sensitive dye. RESULTS: Simultaneous treatment with JX-594 and aldosterone significantly increased viral replication in A2780, PC-3, and HepG2 cell lines, but not in U2OS cell lines. Furthermore, the aldosterone treatment time altered the JX-594 replication according to the cell line. The JX-594 replication peaked after 48 and 24 hours of treatment in PC-3 and HepG2 cells, respectively. qPCR showed that JX-594 entry across the plasma membrane was increased, however, the changes are not significant by the treatment. This was inhibited by treatment with spironolactone (an aldosterone-receptor inhibitor). JX-594 entry was significantly decreased by treatment with EIPA [5-(N-ethyl-N-isopropyl)amiloride; a Na+/H+-exchange inhibitor], but aldosterone significantly restored JX-594 entry even in the presence of EIPA. Intracellular alkalization was observed after aldosterone treatment but was acidified by EIPA treatment. CONCLUSIONS: Aldosterone stimulates JX-594 amplification via increased virus entry by affecting the H+ gradient.

Relationship between adiponectin and cardiac damage induced by aldosterone in SD rats / 中华内分泌代谢杂志

Objective To investigate relationship between adiponectin and cardiac damage induced by aldosterone in SD rats. Methods Male SD rats were treated with aldosterone infusion for 4 weeks, systolic blood pressure (SBP) was measured every week. At the end of experiment, the myocardial structure was observed, the levels of adiponectin in plasma and adiponectin mRNA expression of adipose tissue in epididymal fat pad were measured. 3T3-L1 adipocytes treated with 10-8 and 10-6 moL/L aldosterone for 24 and 48 h, adiponectin mRNA expressions and adiponectin concentrations in culture medium were measured. Results Aldosterone induced only a slight increase in the SBP of SD rats[(123±7)mm Hg, P<0.05]. However, aldosterone significantly induced cardiac ultrastructure changes, such as mitochondrial swelling and disordered internal structures. Furthermore, the level of plasma adiponectin decreased 22.8% after aldosterone treatment for 4 weeks ( P<0. 05 ). When 3T3-L1 adipocytes were treated with 10-8 and 10-6 mol/L aldosterone for 24 h, adiponectin concentrations in culture medium decreased 21.8% and 27. 2%, respectively (P < 0. 05); for 48 h, adiponctin mRNA expressions decreased 22.1% and 37.4%, respectively ( P<0. 05 ). The effect of aldosterone was reversed by spironolactone,which was partly independent of SBP. Conclusions Low level of adiponectin may be involved in cardiac damage induced by aldosterone in SD rats.

Aortic Cell Apoptosis in Rat Primary Aldosteronism Model / 华中科技大学学报（医学）（英德文版）

This study aimed to determine whether aldosterone could induce vascular cell apoptosis in vivo.Thirty-two male rats were randomly divided into 4 groups: vehicle(control),aldosterone,aldosterone plus eplerenone or hydralazine.They were then implanted with an osmotic mini-pump that infused either aldosterone or the vehicle.Systolic blood pressure(SBP)was measured weekly by the tail-cuff method.After 8 weeks,plasma aldosterone concentration(PAC)and renin activity(PRA)were determined by radioimmunoassay.Aortic apoptosis was examined by TUNEL assay.The levels of cytochrome c and caspase-3 were determined by Western blotting and the expression of Bax and Bcl-2 was detected by immnuohistochemistry and Western blotting.The results showed that as compared with control group,aldosterone-infused rats exhibited:(1)an increase in SBP;(2)significantly elevated PAC with depressed PRA;(3)elevated aortic vascular cell apoptosis accompanied with higher levels ofcytochrome c and activated caspase-3; and(4)significantly up-regulated Bax protein with down-regulated Bcl-2.These effects of aldosterone were significantly inhibited after co-administration with eplerenone but not with hydralazine.It was concluded that aldosterone inducedvascular cell apoptosis by its direct effect on the aorta via mineralocorticoid receptors and independently of blood pressure,which may contribute to aldosterone-mediated vascular injury.

Ameliorative effect of adrenalectomy on remnant nephropathy in the rat depends on aldosterone level / 中华肾脏病杂志

4-fold elevation in renal cortex in plasma aldosterone as compared to those of the SHAM rats. The above pathologies were markedly improved in bi-ectomised rats with significantly lower aldosterone level. Being constantly infused exogenous aldosterone, bi-ectomized rats manifested greater proteinuria, hypertension, glomerulosclerosis and increased level of TGF-?1 compared to bi-ectomised rats. Indeed, these features were similar in exogenous aldosterone rats and 5/6 nephrectomized rats. Furthermore, the expression of mineralocorticoid receptor (MR) mRNA was remarkablely enhanced in SNX group and was decreased in ADX group. However, the mRNA expression of 11 ?-hydroxysteroid dehydrogenase II (11?-HSD2) in each group was opposite to that of MRmRNA. Ccr and kidney/body weight showed no differences among four experimental groups. Conclusion Aldosterone contributes to the progression of ablative nephropathy in the rat through mechanisms other than systolic blood pressure.