Dept of Pulmonology, Amsterdam UMC, Amsterdam, The Netherlands.
Dept of Physiology, Amsterdam UMC, Amsterdam, The Netherlands.
Eur Respir J. 2021 Oct 28;58(4). doi: 10.1183/13993003.04633-2020. Print 2021 Oct.
Pulmonary hypertension is a fatal condition of elevated pulmonary pressures, complicated by right heart failure. Pulmonary hypertension appears in various forms; one of those is pulmonary arterial hypertension (PAH) and is particularly characterised by progressive remodelling and obstruction of the smaller pulmonary vessels. Neurohormonal imbalance in PAH patients is associated with worse prognosis and survival. In this back-to-basics article on neurohormonal modulation in PAH, we provide an overview of the pharmacological and nonpharmacological strategies that have been tested pre-clinically and clinically. The benefit of neurohormonal modulation strategies in PAH patients has been limited by lack of insight into how the neurohormonal system is changed throughout the disease and difficulties in translation from animal models to human trials. We propose that longitudinal and individual assessments of neurohormonal status are required to improve the timing and specificity of neurohormonal modulation strategies. Ongoing developments in imaging techniques such as positron emission tomography may become helpful to determine neurohormonal status in PAH patients in different disease stages and optimise individual treatment responses.
肺动脉高压是一种由肺动脉压力升高引起的致命病症，常伴有右心衰竭。肺动脉高压有多种形式，其中一种是肺动脉高压（PAH），其特征为较小的肺血管进行性重塑和阻塞。PAH 患者的神经激素失衡与预后和生存较差相关。在这篇关于 PAH 神经激素调节的基础知识文章中，我们概述了已在临床前和临床中测试的药理学和非药理学策略。神经激素调节策略在 PAH 患者中的益处受到限制，原因是缺乏对整个疾病过程中神经激素系统如何变化的深入了解，以及从动物模型到人体试验的转化困难。我们提出，需要对神经激素状态进行纵向和个体化评估，以改善神经激素调节策略的时机和特异性。正电子发射断层扫描等成像技术的不断发展可能有助于确定不同疾病阶段 PAH 患者的神经激素状态，并优化个体治疗反应。
