Červenka L, Melenovský V, Husková Z, Sporková A, Bürgelová M, Škaroupková P, Hwang S H, Hammock B D, Imig J D, Sadowski J
Department of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Physiol Res. 2015;64(6):857-73. doi: 10.33549/physiolres.932977. Epub 2015 Jun 5.
The detailed mechanisms determining the course of congestive heart failure (CHF) and associated renal dysfunction remain unclear. In a volume overload model of CHF induced by creation of aorto-caval fistula (ACF) in Hannover Sprague-Dawley (HanSD) rats we explored the putative pathogenetic contribution of epoxyeicosatrienoic acids (EETs), active products of CYP-450 dependent epoxygenase pathway of arachidonic acid metabolism, and compared it with the role of the renin-angiotensin system (RAS). Chronic treatment with cis-4-[4-(3-adamantan-1-yl-ureido) cyclohexyloxy]benzoic acid (c-AUCB, 3 mg/l in drinking water), an inhibitor of soluble epoxide hydrolase (sEH) which normally degrades EETs, increased intrarenal and myocardial EETs to levels observed in sham-operated HanSD rats, but did not improve the survival or renal function impairment. In contrast, chronic angiotensin-converting enzyme inhibition (ACEi, trandolapril, 6 mg/l in drinking water) increased renal blood flow, fractional sodium excretion and markedly improved survival, without affecting left ventricular structure and performance. Hence, renal dysfunction rather than cardiac remodeling determines long-term mortality in advanced stage of CHF due to volume overload. Strong protective actions of ACEi were associated with suppression of the vasoconstrictor/sodium retaining axis and activation of vasodilatory/natriuretic axis of the renin-angiotensin system in the circulating blood and kidney tissue.
决定充血性心力衰竭(CHF)病程及相关肾功能障碍的详细机制仍不清楚。在通过在汉诺威斯普拉格 - 道利(HanSD)大鼠建立主动脉 - 腔静脉瘘(ACF)诱导的CHF容量超负荷模型中,我们探究了环氧二十碳三烯酸(EETs)(花生四烯酸代谢的CYP - 450依赖性环氧合酶途径的活性产物)可能的致病作用,并将其与肾素 - 血管紧张素系统(RAS)的作用进行比较。用顺式 - 4 - [4 - (3 - 金刚烷 - 1 - 基 - 脲基)环己氧基]苯甲酸(c - AUCB,饮用水中3 mg/l)进行慢性治疗,c - AUCB是一种可溶性环氧化物水解酶(sEH)抑制剂,正常情况下可降解EETs,它可使肾内和心肌EETs水平升高至假手术HanSD大鼠中观察到的水平,但并未改善生存率或肾功能损害。相比之下,慢性血管紧张素转换酶抑制(ACEi,群多普利,饮用水中6 mg/l)可增加肾血流量、钠排泄分数并显著提高生存率,而不影响左心室结构和功能。因此,在因容量超负荷导致的CHF晚期,肾功能障碍而非心脏重塑决定长期死亡率。ACEi的强大保护作用与循环血液和肾组织中肾素 - 血管紧张素系统的血管收缩/保钠轴的抑制以及血管舒张/利钠轴的激活有关。