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HMG-CoA还原酶抑制剂在糖尿病微血管病变中的调节作用。

Modulatory effects of HMG-CoA reductase inhibitors in diabetic microangiopathy.

作者信息

Danesh Farhad R, Kanwar Yashpal S

机构信息

Division of Nephrology/Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA .

出版信息

FASEB J. 2004 May;18(7):805-15. doi: 10.1096/fj.03-0839rev.

Abstract

3-hydroxy-3-methyl-glutaryl CoA (HMG-CoA) reductase inhibitors or statins are competitive inhibitors of the rate-limiting enzyme in cholesterol biosynthesis. Several large landmark clinical studies have shown a marked reduction of cardiovascular mortality and morbidity in patients treated with statins. Because of the strong association between serum cholesterol levels and coronary artery disease, investigators initially assumed that the predominant beneficial effects of statins result from their lipid-lowering properties. However, more recent observations have suggested that the clinical benefits of statins may be in part independent of their cholesterol-lowering effects. The pleiotropic or cholesterol-independent effects of statins might result from preventing the production of isoprenoids. Isoprenoids serve as important lipid attachments for the post-translational modification of a variety of proteins such as small GTP binding proteins implicated in intracellular signaling. The list of different pleiotropic effects of statins is still growing and, among others, includes the modulatory effects of statins on endothelial function, oxidative stress, coagulation, plaque stability, and inflammation. The pleiotropic effects of statins represent an area of great interest in prevention and therapy of cardiovascular and other chronic diseases. An area of particular interest is the potential beneficial effects of statins in diabetes and its micro/macrovascular complications. This review summarizes our current understanding of the pleiotropic effects of statins in diabetes and the modulatory effects of statins in various pathobiological pathways involved in diabetes and its complications.

摘要

3-羟基-3-甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂或他汀类药物是胆固醇生物合成限速酶的竞争性抑制剂。几项具有里程碑意义的大型临床研究表明,接受他汀类药物治疗的患者心血管死亡率和发病率显著降低。由于血清胆固醇水平与冠状动脉疾病之间存在密切关联,研究人员最初认为他汀类药物的主要有益作用源于其降脂特性。然而,最近的观察结果表明,他汀类药物的临床益处可能部分独立于其降脂作用。他汀类药物的多效性或非胆固醇依赖性作用可能是由于阻止了类异戊二烯的产生。类异戊二烯作为多种蛋白质翻译后修饰的重要脂质附着基团,如参与细胞内信号传导的小GTP结合蛋白。他汀类药物不同多效性作用的清单仍在不断增加,其中包括他汀类药物对内皮功能、氧化应激、凝血、斑块稳定性和炎症的调节作用。他汀类药物的多效性作用是心血管和其他慢性疾病预防和治疗中一个备受关注的领域。一个特别感兴趣的领域是他汀类药物在糖尿病及其微血管/大血管并发症中的潜在有益作用。本综述总结了我们目前对他汀类药物在糖尿病中的多效性作用以及他汀类药物在糖尿病及其并发症涉及的各种病理生物学途径中的调节作用的理解。

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