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替米沙坦可改善射血分数保留型心力肾衰所致的心肌纤维化和舒张功能障碍。

Telmisartan ameliorates cardiac fibrosis and diastolic function in cardiorenal heart failure with preserved ejection fraction.

机构信息

Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.

出版信息

Exp Biol Med (Maywood). 2021 Dec;246(23):2511-2521. doi: 10.1177/15353702211035058. Epub 2021 Aug 3.

Abstract

Chronic kidney disease (CKD) is a major contributor to the development of heart failure with preserved ejection fraction (HFpEF), whereas the underlying mechanism of cardiorenal HFpEF is still elusive. The aim of this study was to investigate the role of cardiac fibrosis in a rat model of cardiorenal HFpEF and explore whether treatment with Telmisartan, an inhibitor of renin-angiotensin-aldosterone system (RAAS), can ameliorate cardiac fibrosis and preserve diastolic function in cardiorenal HFpEF. Male rats were subjected to 5/6 subtotal nephrectomy (SNX) or sham operation (Sham), and rats were allowed four weeks to recover and form a stable condition of CKD. Telmisartan or vehicle was then administered p.o. (8 mg/kg/d) for 12 weeks. Blood pressure, brain natriuretic peptide (BNP), echocardiography, and cardiac magnetic resonance imaging were acquired to evaluate cardiac structural and functional alterations. Histopathological staining, real-time polymerase chain reaction (PCR) and western blot were performed to evaluate cardiac remodeling. SNX rats showed an HFpEF phenotype with increased BNP, decreased early to late diastolic transmitral flow velocity (E/A) ratio, increased left ventricular (LV) hypertrophy and preserved ejection fraction (EF). Pathology revealed increased cardiac fibrosis in cardiorenal HFpEF rats compared with the Sham group, while chronic treatment with Telmisartan significantly decreased cardiac fibrosis, accompanied by reduced markers of fibrosis (collagen I and collagen III) and profibrotic cytokines (α-smooth muscle actin, transforming growth factor-β1, and connective tissue growth factor). In addition, myocardial inflammation was decreased after Telmisartan treatment, which was in a linear correlation with cardiac fibrosis. Telmisartan also reversed LV hypertrophy and E/A ratio, indicating that Telmisartan can improve LV remodeling and diastolic function in cardiorenal HFpEF. In conclusion, cardiac fibrosis is central to the pathology of cardiorenal HFpEF, and RAAS modulation with Telmisartan is capable of alleviating cardiac fibrosis and preserving diastolic dysfunction in this rat model.

摘要

慢性肾脏病(CKD)是射血分数保留型心力衰竭(HFpEF)发展的主要因素,而心脏肾 HFpEF 的潜在机制仍难以捉摸。本研究旨在探讨心脏纤维化在心脏肾 HFpEF 大鼠模型中的作用,并探讨血管紧张素转化酶抑制剂替米沙坦(一种肾素-血管紧张素-醛固酮系统(RAAS)抑制剂)治疗是否能改善心脏纤维化并保留心脏肾 HFpEF 的舒张功能。雄性大鼠接受 5/6 肾部分切除术(SNX)或假手术(Sham),大鼠允许四周恢复并形成 CKD 的稳定状态。然后,替米沙坦或载体通过口服(8mg/kg/d)给药 12 周。采集血压、脑钠肽(BNP)、超声心动图和心脏磁共振成像来评估心脏结构和功能改变。进行组织病理学染色、实时聚合酶链反应(PCR)和蛋白质印迹分析来评估心脏重构。SNX 大鼠表现出 HFpEF 表型,BNP 增加,早期到晚期舒张期二尖瓣血流速度(E/A)比值降低,左心室(LV)肥大和射血分数(EF)保留。与 Sham 组相比,心脏肾 HFpEF 大鼠的心脏纤维化增加,而替米沙坦的慢性治疗显著减少了心脏纤维化,同时减少了纤维化标志物(I 型和 III 型胶原)和促纤维化细胞因子(α-平滑肌肌动蛋白、转化生长因子-β1 和结缔组织生长因子)。此外,替米沙坦治疗后心肌炎症减少,与心脏纤维化呈线性相关。替米沙坦还逆转了 LV 肥大和 E/A 比值,表明替米沙坦可以改善心脏肾 HFpEF 中的 LV 重构和舒张功能。总之,心脏纤维化是心脏肾 HFpEF 病理的核心,替米沙坦对 RAAS 的调节能够缓解该大鼠模型中的心脏纤维化和舒张功能障碍。

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