肾素-血管紧张素-醛固酮系统调节在糖尿病肾病中的潜力:旧有靶点带来新希望!

Potential of Renin-Angiotensin-Aldosterone System Modulations in Diabetic Kidney Disease: Old Players to New Hope!

机构信息

Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Pilani, Rajasthan, India.

Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM's NMIMS, Mumbai, India.

出版信息

Rev Physiol Biochem Pharmacol. 2021;179:31-71. doi: 10.1007/112_2020_50.

Abstract

Due to a tragic increase in the incidences of diabetes globally, diabetic kidney disease (DKD) has emerged as one of the leading causes of end-stage renal diseases (ESRD). Hyperglycaemia-mediated overactivation of the renin-angiotensin-aldosterone system (RAAS) is key to the development and progression of DKD. Consequently, RAAS inhibition by angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) is the first-line therapy for the clinical management of DKD. However, numerous clinical and preclinical evidences suggested that RAAS inhibition can only halt the progression of the DKD to a certain extent, and they are inadequate to cure DKD completely. Recent studies have improved understanding of the complexity of the RAAS. It consists of two counter-regulatory arms, the deleterious pressor arm (ACE/angiotensin II/AT1 receptor axis) and the beneficial depressor arm (ACE2/angiotensin-(1-7)/Mas receptor axis). These advances have paved the way for the development of new therapies targeting the RAAS for better treatment of DKD. In this review, we aimed to summarise the involvement of the depressor arm of the RAAS in DKD. Moreover, in modern drug discovery and development, an advance approach is the bispecific therapeutics, targeting two independent signalling pathways. Here, we discuss available reports of these bispecific drugs involving the RAAS as well as propose potential treatments based on neurohormonal balance as credible therapeutic strategies for DKD.

摘要

由于全球糖尿病发病率的悲惨增加,糖尿病肾病 (DKD) 已成为终末期肾病 (ESRD) 的主要原因之一。高血糖介导的肾素-血管紧张素-醛固酮系统 (RAAS) 的过度激活是 DKD 发展和进展的关键。因此,血管紧张素转换酶抑制剂 (ACEi) 或血管紧张素受体阻滞剂 (ARB) 的 RAAS 抑制是 DKD 临床管理的一线治疗方法。然而,大量的临床和临床前证据表明,RAAS 抑制只能在一定程度上阻止 DKD 的进展,它们不足以完全治愈 DKD。最近的研究提高了对 RAAS 复杂性的理解。它由两个拮抗调节臂组成,有害的升压臂(ACE/血管紧张素 II/AT1 受体轴)和有益的降压臂(ACE2/血管紧张素-(1-7)/Mas 受体轴)。这些进展为开发针对 RAAS 的新疗法以更好地治疗 DKD 铺平了道路。在这篇综述中,我们旨在总结 RAAS 的降压臂在 DKD 中的作用。此外,在现代药物发现和开发中,一种先进的方法是双特异性治疗剂,针对两个独立的信号通路。在这里,我们讨论了这些涉及 RAAS 的双特异性药物的现有报告,并提出了基于神经激素平衡的潜在治疗方法,作为 DKD 的可信治疗策略。

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