醛固酮合酶
醛固酮
盐皮质激素受体
盐皮质激素
甾体11β-羟化酶
内分泌学
医学
内科学
肾
血管紧张素II
肾素-血管紧张素系统
药理学
血压
类固醇
激素
作者
Subodh Verma,A. Shekhar Pandey,Arjun Pandey,Javed Butler,John S. Lee,Hwee Teoh,C. David Mazer,Mikhail Kosiborod,Francesco Cosentino,Stefan D. Anker,Kim A. Connelly,Deepak L. Bhatt
出处
期刊:American Journal of Physiology-heart and Circulatory Physiology
[American Physiological Society]
日期:2023-12-22
被引量:1
标识
DOI:10.1152/ajpheart.00419.2023
摘要
Modulation of the renin-angiotensin-aldosterone system is a foundation of therapy for cardiovascular and kidney diseases. Excess aldosterone plays an important role in cardiovascular disease, contributing to inflammation, fibrosis and dysfunction in the heart, kidneys, and vasculature through both genomic, mineralocorticoid receptor (MR)-mediated, as well as non-genomic mechanisms. MR antagonists have been a key therapy for attenuating the pathologic effects of aldosterone but are associated with some side effects and may not always adequately attenuate the non-genomic effects of aldosterone. Aldosterone is primarily synthesized by the CYP11B2 aldosterone synthase enzyme, which is very similar in structure to other enzymes involved in steroid biosynthesis including CYP11B1, a key enzyme is involved in glucocorticoid production. Lack of specificity for CYP11B2, off-target effects on the hypothalamic-pituitary-adrenal axis, and counterproductive increased levels of bioactive steroid intermediates such as 11-deoxycorticosterone have posed challenges in the development of early aldosterone synthase inhibitors such as osilodrostat. In early phase clinical trials, newer aldosterone synthase inhibitors demonstrated promise in lowering blood pressure in patients with treatment-resistant and uncontrolled hypertension. It is therefore plausible that these agents offer protection in other disease states including heart failure or chronic kidney disease. Further clinical evaluation will be needed to clarify the role of aldosterone synthase inhibitors, a promising class of agents which represent a potentially major therapeutic advance.
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