Esteva-Font Cristina, Anderson Marc O, Verkman Alan S
Departments of Medicine and Physiology, University of California, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
Department of Chemistry and Biochemistry, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA.
Nat Rev Nephrol. 2015 Feb;11(2):113-23. doi: 10.1038/nrneph.2014.219. Epub 2014 Dec 9.
Conventional diuretics such as furosemide and thiazides target salt transporters in kidney tubules, but urea transporters (UTs) have emerged as alternative targets. UTs are a family of transmembrane channels expressed in a variety of mammalian tissues, in particular the kidney. UT knockout mice and humans with UT mutations exhibit reduced maximal urinary osmolality, demonstrating that UTs are necessary for the concentration of urine. Small-molecule screening has identified potent and selective inhibitors of UT-A, the UT protein expressed in renal tubule epithelial cells, and UT-B, the UT protein expressed in vasa recta endothelial cells. Data from UT knockout mice and from rodents administered UT inhibitors support the diuretic action of UT inhibition. The kidney-specific expression of UT-A1, together with high selectivity of the small-molecule inhibitors, means that off-target effects of such small-molecule drugs should be minimal. This Review summarizes the structure, expression and function of UTs, and looks at the evidence supporting the validity of UTs as targets for the development of salt-sparing diuretics with a unique mechanism of action. UT-targeted inhibitors may be useful alone or in combination with conventional diuretics for therapy of various oedemas and hyponatraemias, potentially including those refractory to treatment with current diuretics.
传统利尿剂如呋塞米和噻嗪类药物作用于肾小管中的盐转运蛋白,但尿素转运蛋白(UTs)已成为替代靶点。UTs是一类跨膜通道家族,在多种哺乳动物组织中表达,尤其是在肾脏。UT基因敲除小鼠和携带UT突变的人类表现出最大尿渗透压降低,这表明UTs对于尿液浓缩是必需的。小分子筛选已鉴定出肾小管上皮细胞中表达的UT蛋白UT-A和直小血管内皮细胞中表达的UT蛋白UT-B的强效和选择性抑制剂。来自UT基因敲除小鼠和给予UT抑制剂的啮齿动物的数据支持UT抑制的利尿作用。UT-A1的肾脏特异性表达,加上小分子抑制剂的高选择性,意味着此类小分子药物的脱靶效应应该最小。本综述总结了UTs的结构、表达和功能,并探讨了支持UTs作为具有独特作用机制的保盐利尿剂开发靶点有效性的证据。靶向UT的抑制剂单独使用或与传统利尿剂联合使用可能对各种水肿和低钠血症的治疗有用,可能包括那些对当前利尿剂治疗难治的情况。