Suganami Takayoshi, Mori Kiyoshi, Tanaka Issei, Mukoyama Masashi, Sugawara Akira, Makino Hisashi, Muro Seiji, Yahata Kensei, Ohuchida Shuichi, Maruyama Takayuki, Narumiya Shuh, Nakao Kazuwa
Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Hypertension. 2003 Dec;42(6):1183-90. doi: 10.1161/01.HYP.0000101689.64849.97.
One of the major causes of end-stage renal diseases is hypertensive renal disease, in which enhanced renal prostaglandin (PG) E2 production has been shown. PGE2, a major arachidonic acid metabolite produced in the kidney, acts on 4 receptor subtypes, EP1 through EP4, but the pathophysiological importance of the PGE2/EP subtypes in the development of hypertensive renal injury remains to be elucidated. In this study, we investigated whether an orally active EP1-selective antagonist (EP1A) prevents the progression of renal damage in stroke-prone spontaneously hypertensive rats (SHRSP), a model of human malignant hypertension. Ten-week-old SHRSP, with established hypertension but with minimal renal damage, were given EP1A or vehicle for 5 weeks. After the treatment period, vehicle-treated SHRSP showed prominent proliferative lesions in arterioles, characterized by decreased alpha-smooth muscle actin expression in multilayered vascular smooth muscle cells. Upregulation of transforming growth factor-beta expression and tubulointerstitial fibrosis were also observed in vehicle-treated SHRSP. All these changes were dramatically attenuated in EP1A-treated SHRSP. Moreover, EP1A treatment significantly inhibited both increase in urinary protein excretion and decrease in creatinine clearance but had little effect on systemic blood pressure. These findings indicate that the PGE2/EP1 signaling pathway plays a crucial role in the development of renal injury in SHRSP. This study opens a novel therapeutic potential of selective blockade of EP1 for the treatment of hypertensive renal disease.
终末期肾病的主要病因之一是高血压肾病,其中已显示肾脏前列腺素(PG)E2生成增加。PGE2是肾脏中产生的主要花生四烯酸代谢产物,作用于4种受体亚型,即EP1至EP4,但PGE2/EP亚型在高血压肾损伤发展中的病理生理重要性仍有待阐明。在本研究中,我们调查了口服活性EP1选择性拮抗剂(EP1A)是否能预防易中风自发性高血压大鼠(SHRSP)(一种人类恶性高血压模型)的肾损伤进展。对10周龄、已患高血压但肾损伤轻微的SHRSP给予EP1A或赋形剂,持续5周。治疗期结束后,给予赋形剂的SHRSP在小动脉中出现明显的增殖性病变,其特征是多层血管平滑肌细胞中α平滑肌肌动蛋白表达减少。在给予赋形剂的SHRSP中还观察到转化生长因子-β表达上调和肾小管间质纤维化。所有这些变化在给予EP1A的SHRSP中均显著减轻。此外,EP1A治疗显著抑制了尿蛋白排泄增加和肌酐清除率降低,但对全身血压影响不大。这些发现表明,PGE2/EP1信号通路在SHRSP肾损伤的发展中起关键作用。本研究为选择性阻断EP1治疗高血压肾病开辟了新的治疗潜力。