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1.
J Med Chem ; 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38647397

RESUMO

Research into kappa opioid receptor (KOR) agonists with attenuated central-nervous-system side effects is a critical focus for developing productive and safe analgesics. Herein, a series of ortho-substituted N-cyclopropylmethyl-7α-phenyl-6,14-endoethano-tetrahydronorthebaines were designed, synthesized, and subjected to bioassays. Compound 7a exhibited high subtype selectivity and potent agonistic activity toward KOR (KOR, Ki = 3.9 nM, MOR/KOR = 270, DOR/KOR = 1075; [35S]GTPγS binding, EC50 = 3.4 nM). Additionally, this compound exhibited robust and persistent antinociceptive effects in rodent models with different animal strains (hot plate test, ED50 = 0.20-0.30 mg/kg, i.p.; abdominal constriction test, ED50 = 0.20-0.60 mg/kg, i.p.), with its KOR-mediated mechanism for antinociception firmly established. Notably, compound 7a, unlike conventional KOR agonists, displayed minimal sedation and aversion at the antinociceptive ED50 dose. This feature addresses a crucial limitation in existing KOR agonists, positioning compound 7a as a promising novel therapeutic agent.

2.
J Med Chem ; 67(6): 5075-5092, 2024 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-38483150

RESUMO

Aberrantly elevated adenosine in the tumor microenvironment exerts its immunosuppressive functions through adenosine receptors A2AR and A2BR. Antagonism of A2AR and A2BR has the potential to suppress tumor growth. Herein, we report a systemic assessment of the effects of an indole modification at position 4, 5, 6, or 7 on both A2AR/A2BR activity and selectivity of novel 2-aminopyrimidine compounds. Substituting indole at the 4-/5-position produced potent A2AR/A2BR dual antagonism, whereas the 6-position of indole substitution gave highly selective A2BR antagonism. Molecular dynamics simulation showed that the 5-cyano compound 7ai had a lower binding free energy than the 6-cyano compound 7aj due to water-bridged hydrogen bond interactions with E169 or F168 in A2AR. Of note, dual A2AR/A2BR antagonism by compound 7ai can profoundly promote the activation and cytotoxic function of T cells. This work provided a strategy for obtaining novel dual A2AR/A2BR or A2BR antagonists by fine-tuning structural modification.


Assuntos
Pirimidinas , Receptor A2A de Adenosina , Receptor A2B de Adenosina , Receptor A2A de Adenosina/metabolismo , Receptor A2B de Adenosina/metabolismo , Adenosina/metabolismo , Indóis
3.
J Biophotonics ; : e202300480, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38351740

RESUMO

Fluorescence molecular tomography (FMT), as a promising technique for early tumor detection, can non-invasively visualize the distribution of fluorescent marker probe three-dimensionally. However, FMT reconstruction is a severely ill-posed problem, which remains an obstacle to wider application of FMT. In this paper, a two-step reconstruction framework was proposed for FMT based on the energy statistical probability. First, the tissue structural information obtained from computed tomography (CT) is employed to associate the tissue optical parameters for rough solution in the global region. Then, according to the global-region reconstruction results, the probability that the target belongs to each region can be calculated. The region with the highest probability is delineated as region of interest to realize accurate and fast source reconstruction. Numerical simulations and in vivo experiments were carried out to evaluate the effectiveness of the proposed framework. The encouraging results demonstrate the significant effectiveness and potential of our method for practical FMT applications.

4.
Sci China Life Sci ; 2024 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-38319473

RESUMO

The adenosine subfamily G protein-coupled receptors A2AR and A2BR have been identified as promising cancer immunotherapy candidates. One of the A2AR/A2BR dual antagonists, AB928, has progressed to a phase II clinical trial to treat rectal cancer. However, the precise mechanism underlying its dual-antagonistic properties remains elusive. Herein, we report crystal structures of the A2AR complexed with AB928 and a selective A2AR antagonist 2-118. The structures revealed a common binding mode on A2AR, wherein the ligands established extensive interactions with residues from the orthosteric and secondary pockets. In contrast, the cAMP assay and A2AR and A2BR molecular dynamics simulations indicated that the ligands adopted distinct binding modes on A2BR. Detailed analysis of their chemical structures suggested that AB928 readily adapted to the A2BR pocket, while 2-118 did not due to intrinsic differences. This disparity potentially accounted for the difference in inhibitory efficacy between A2BR and A2AR. This study serves as a valuable structural template for the future development of selective or dual inhibitors targeting A2AR/A2BR for cancer therapy.

5.
Zhongguo Yi Liao Qi Xie Za Zhi ; 48(1): 85-87, 2024 Jan 30.
Artigo em Chinês | MEDLINE | ID: mdl-38384223

RESUMO

This study conducted statistics on the special review applications for Class Ⅱ innovative medical devices in Shanghai from April 2020 to April 2023. It summarized and analyzed common problems in the innovation review application stage, and gave suggestions for applicants and reviewers in order to further improve the quality of innovation application and improve the pass rate of innovation applications.


Assuntos
Equipamentos e Provisões , China , Invenções
6.
Nanoscale Adv ; 6(2): 489-498, 2024 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-38235095

RESUMO

Femtosecond (fs) laser irradiation inside transparent materials has drawn considerable interest over the past two decades. More specifically, self-assembled nanogratings, induced by fs laser direct writing (FLDW) inside glass, enable a broad range of potential applications in optics, photonics, or microfluidics. In this work, a comprehensive study of nanogratings formed inside fused silica by FLDW is presented based on high-resolution electron microscopy imaging techniques. These nanoscale investigations reveal that the intrinsic structure of nanogratings is composed of oblate nanopores, shaped into nanoplanes, regularly spaced and oriented perpendicularly to the laser polarization. These nanoporous layers are forced-organized by light, resulting in a pseudo-organized spacing at the sub-wavelength scale, and observed in a wide range of optical glasses. In light of the current state of the art, we discuss the imprinting of nanoporous layers under thermomechanical effects induced by a plasma-mediated nanocavitation process.

7.
J Med Chem ; 66(23): 16091-16108, 2023 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-37982494

RESUMO

The master transcription factor receptor retinoic acid receptor-related orphan receptor γt (RORγt) regulates the differentiation of T-helper 17 (Th17) cells and the production of interleukin-17 (IL-17). Activation of RORγt+ T cells in the tumor microenvironment promotes immune infiltration to more effectively inhibit tumor growth. Therefore, RORγt agonists provide a reachable approach to cancer immunotherapy. Herein, a series of biaryl amide derivatives as novel RORγt agonists were designed, synthesized, and evaluated. Starting from the reported RORγt inverse agonist GSK805 (1), "functionality switching" and structure-based drug optimization led to the discovery of a promising RORγt agonist lead compound 14, which displayed potent and selective RORγt agonist activity and significantly improved metabolic stability. With excellent in vivo pharmacokinetic profiles, compound 14 demonstrated robust efficacy in preclinical tumor models of mouse B16F10 melanoma and LLC lung adenocarcinoma. Taken together, current studies indicate that 14 deserves further investigation as a potential lead RORγt agonist for cancer immunotherapy.


Assuntos
Amidas , Neoplasias , Camundongos , Animais , Amidas/farmacologia , Amidas/uso terapêutico , Membro 3 do Grupo F da Subfamília 1 de Receptores Nucleares/agonistas , Agonismo Inverso de Drogas , Imunoterapia , Microambiente Tumoral
8.
Artigo em Inglês | MEDLINE | ID: mdl-37807649

RESUMO

Liver failure (LF) is serious liver damage caused by multiple factors, resulting in severe impairment or decompensation of liver synthesis, detoxification, metabolism, and biotransformation. The general prognosis of LF is poor with high mortality in non-transplant patients. The clinical treatments for LF are mainly internal medicine comprehensive care, an artificial liver support system, and liver transplantation. However, none of the above treatment strategies can solve the problems of all liver failure patients and has its own limitations. Mesenchymal stem cells (MSCs) are a kind of stem cells with multidirectional differentiation potential and paracrine function, which play an important role in immune regulation and tissue regeneration. In recent years, MSCs have shown multiple advantages in the treatment of LF in pre-clinical experiments and clinical trials. In this work, we reviewed the biological characteristics of MSCs, the possible molecular mechanisms of MSCs in the treatment of liver failure, animal experiments, and clinical application, and also discussed the existing problems of MSCs in the treatment of liver failure.

9.
Appl Opt ; 62(27): 7156, 2023 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-37855569

RESUMO

This publisher's note contains corrections to Appl. Opt.62, 6794 (2023)APOPAI0003-693510.1364/AO.496351.

10.
Oncogene ; 42(45): 3331-3343, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37752234

RESUMO

The internal tandem duplication of the FMS-like tyrosine kinase 3 (FLT3-ITD) is one of the most frequent genetic alterations in acute myeloid leukemia (AML). Limited and transient clinical benefit of FLT3 kinase inhibitors (FLT3i) emphasizes the need for alternative therapeutic options for this subset of myeloid malignancies. Herein, we showed that FLT3-ITD mutant (FLT3-ITD+) AML cells were susceptible toward inhibitors of DHODH, a rate-limiting enzyme of de novo pyrimidine biosynthesis. Genetic and pharmacological blockade of DHODH triggered downregulation of FLT3-ITD protein, subsequently suppressed activation of downstream ERK and STAT5, and promoted cell death of FLT3-ITD+ AML cells. Mechanistically, DHODH blockade triggered autophagy-mediated FLT3-ITD degradation via inactivating mTOR, a potent autophagy repressor. Notably, blockade of DHODH synergized with an FDA-approved FLT3i quizartinib in significantly impairing the growth of FLT3-ITD+ AML cells and improving tumor-bearing mice survival. We further demonstrated that DHODH blockade exhibited profound anti-proliferation effect on quizartinib-resistant cells in vitro and in vivo. In summary, this study demonstrates that the induction of degradation of FLT3-ITD protein by DHODH blockade may offer a promising therapeutic strategy for AML patients harboring FLT3-ITD mutation.


Assuntos
Di-Hidro-Orotato Desidrogenase , Leucemia Mieloide Aguda , Animais , Humanos , Camundongos , Autofagia , Tirosina Quinase 3 Semelhante a fms/genética , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/patologia , Mutação , Proteínas Oncogênicas/genética , Inibidores de Proteínas Quinases/farmacologia , Pirimidinas/biossíntese , Pirimidinas/metabolismo
11.
Biochem Mol Biol Educ ; 51(6): 662-669, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37665065

RESUMO

With the emergence of innovative technologies, including combinatorial chemistry, high-throughput screening, computer-aided drug design (CADD), artificial intelligence (AI) and big data, the importance of drug design in the field of drug discovery and development is increasing. Additionally, education in drug design plays an important role in the training of pharmaceutical talent. Starting with undergraduates, cultivating pharmaceutical design thinking, developing innovation and creativity, and establishing an interdisciplinary knowledge system will not only provide students with a solid knowledge basis but also promote the development of the pharmaceutical industry in China. This article presents the current status of pharmaceutical education and the distribution of drug design courses in China and summarizes the employment prospects of graduates, thus providing valuable references and evidence for global pharmaceutical design education.


Assuntos
Currículo , Educação em Farmácia , Humanos , Inteligência Artificial , Indústria Farmacêutica , Desenho de Fármacos
12.
Appl Opt ; 62(25): 6794-6801, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37706813

RESUMO

The thermal stability of self-assembled porous nanogratings inscribed by an infrared femtosecond (fs) laser in five commercial glasses (BK7, soda lime, 7059, AF32, and Eagle XG) is monitored using step isochronal annealing experiments. Their erasure, ascertained by retardance measurements and attributed to the collapse of nanopores, is well predicted from the Rayleigh-Plesset (R-P) equation. This finding is thus employed to theoretically predict the erasure of nanogratings in the context of any time-temperature process (e.g., thermal annealing, laser irradiation process). For example, in silica glass (Suprasil CG) and using a simplified form of the R-P equation, nanogratings composed of 50 nm will erase within ∼30m i n, ∼1µs, and ∼30n s at temperatures of ∼1250∘ C, 2675°C, and 3100°C, respectively. Such conclusions are expected to provide guidelines to imprint nanogratings in oxide glasses (for instance, in the choice of laser parameters) or to design appropriate thermal annealing protocols for temperature sensing.

13.
Pathogens ; 12(9)2023 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-37764902

RESUMO

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a rare and severe form of end-stage liver disease with high mortality; gut microbes are strongly associated with the development of this severe liver disease but the exact association is unclear. Artificial liver support systems (ALSS) are clinically important in prolonging the waiting time for liver transplantation and in aiding drug therapy to achieve remission. The aim of this study was to investigate the effect of ALSS on the abundance and diversity of microorganisms in the gut of HBV-ACLF patients. In this study, 109 stool samples were collected from patients with hepatitis B virus-associated acute chronic liver failure (HBV-ACLF) for 16S rRNA sequencing. Among them, 44 samples were from patients treated with ALSS therapy as an adjunct to standard medical treatment (SMT) and 65 were from patients receiving SMT only. Analysis of the sequencing results suggested that there were significant differences in the abundance and diversity of gut microbiota between the with-ALSS and without-ALSS groups (p < 0.05). The operational taxonomic units and Shannon indexes indicated that the diversity and abundance of the gut microbiome, while decreasing after the first ALSS treatment, gradually increased after an increase in the number of ALSS therapies. The overall proportion of HBV-ACLF patients with coinfection was 27.59%; the coinfection can reduce the abundance of the Bacteroidetes phylum in the microbiome significantly whereas Proteobacteria were highly enriched. After ALSS therapy, HBV-ACLF patients had a decrease in potentially harmful bacteria, an increase in potentially beneficial bacteria, an increase in the diversity of the intestinal microbiota, and the intestinal microecological disorders were corrected to a certain extent. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) levels, as well as the international normalized ratio (INR), showed a decreasing trend whereas plasminogen activity (PTA) increased and the condition of patients with HBV-ACLF progressed in a favorable direction. In addition, the abundance of Blautia and Coprococcus was negatively correlated with TBIL and INR, positively correlated with PTA, and positively correlated with disease recovery. Our study shows that ALSS can alter the composition of the gut microbiota and have an ameliorating effect on the gut microecological imbalance in HBV-ACLF patients. It is worth mentioning that Blautia and Coprococcus may have great potential as biomarkers.

14.
SLAS Discov ; 28(8): 385-393, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37399991

RESUMO

Tau tubulin kinase 1 (TTBK1) is a serine/threonine/tyrosine kinase that phosphorylates multiple residues in tau protein. Hyperphosphorylated tau is the main cause of tauopathy, such as Alzheimer's disease (AD). Therefore, preventing tau phosphorylation by inhibiting TTBK1 has been proposed as a therapeutic strategy for AD. However, few substrates of TTBK1 are reported for a biochemical assay and few inhibitors targeting TTBK1 have been reported so far. In this study, we identified a fluorescein amidite (FAM)-labeled peptide 15 from a small peptide library as the optimal peptide substrate for human TTBK1 (hTTBK1). We then developed and validated a microfluidics-based mobility shift assay (MMSA) with peptide 15. We further confirmed that peptide 15 could also be used in the ADP-Glo kinase assay. The established MMSA was applied for screening of a 427-compound kinase inhibitor library, yielding five compounds with IC50s of several micro molars against hTTBK1. Among them, three compounds, AZD5363, A-674,563 and GSK690693 inhibited hTTBK1 in an ATP competitive manner and molecular docking simulations revealed that they enter the ATP pocket and form one or two hydrogen bonds to the hinge region with hTTBK1. Another hit compound, piceatannol, showed non-ATP competitive inhibitory effect on hTTBK1 and may serve as a starting point to develop highly selective hTTBK1 inhibitors. Altogether, this study provided a new in vitro platform for the development of novel hTTBK1 inhibitors that might have potential applications in AD prevention.


Assuntos
Doença de Alzheimer , Microfluídica , Humanos , Ensaio de Desvio de Mobilidade Eletroforética , Simulação de Acoplamento Molecular , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/metabolismo , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/química , Peptídeos , Trifosfato de Adenosina
15.
Eur J Med Chem ; 258: 115589, 2023 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-37413884

RESUMO

The discovery and development of novel µ-opioid receptor (MOR) antagonists is a significant area to combat Opioid Use Disorder (OUD). In this work, a series of para-substituted N-cyclopropylmethyl-nornepenthone derivatives were designed and synthesized and pharmacologically assayed. Compound 6a was identified as a selective MOR antagonist both in vitro and in vivo. Its molecular basis was elucidated using molecular docking and MD simulations. A subpocket on the extracellular side of the TM2 domain of MOR, in particular the residue Y2.64, was proposed to be responsible for the reversal of subtype selectivity and functional reversal of this compound.


Assuntos
Morfinanos , Morfinanos/química , Simulação de Acoplamento Molecular , Relação Estrutura-Atividade , Ligantes , Receptores Opioides mu , Antagonistas de Entorpecentes/farmacologia
16.
Opt Express ; 31(10): 15449-15460, 2023 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-37157646

RESUMO

Self-assembled nanogratings, inscribed by femtosecond laser writing in volume, are demonstrated in multicomponent alkali and alkaline earth containing alumino-borosilicate glasses. The laser beam pulse duration, pulse energy, and polarization, were varied to probe the nanogratings existence as a function of laser parameters. Moreover, laser-polarization dependent form birefringence, characteristic of nanogratings, was monitored through retardance measurements using polarized light microscopy. Glass composition was found to drastically impact the formation of nanogratings. For a sodium alumino-borosilicate glass, a maximum retardance of 168 nm (at 800 fs and 1000 nJ) could be measured. The effect of composition is discussed based on SiO2 content, B2O3/Al2O3 ratio, and the Type II processing window is found to decrease as both (Na2O + CaO)/Al2O3 and B2O3/Al2O3 ratios increase. Finally, an interpretation in the ability to form nanogratings from a glass viscosity viewpoint, and its dependency with respect to the temperature, is demonstrated. This work is brought into comparison with previously published data on commercial glasses, which further indicates the strong link between nanogratings formation, glass chemistry, and viscosity.

17.
Eur J Med Chem ; 256: 115424, 2023 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-37167779

RESUMO

Retinoic Acid Receptor-Related Orphan Receptor γt (RORγt) has been exploited as a promising target for the new small molecule therapeutics to treat inflammatory and autoimmune diseases via modulating the interleukin-17 (IL-17) production by T helper 17 (Th17) cells. Herein, we reported a series of triazine-based derivatives as novel RORγt inverse agonists. By screening of our in-house compound library, the hit compound 1 was identified with weak RORγt inhibitory activity. Subsequently, we engineered detailed structural modifications to explore the structure-activity relationships (SARs) of triazines derivatives, which led to discovery of a number of potent RORγt inverse agonists with IC50 values in the range of 7 nM-50 nM in RORγt dual FRET assay. Among them, compound 14g displayed potent RORγt inverse agonistic activity with an IC50 value of 22.9 nM in dual FRET assay. In a cell-based reporter gene assay, compound 14g showed an IC50 value of 0.428 µM and maximum inhibition rate of 108.9%. Compound 14g also exhibited good metabolic stability and a decent pharmacokinetic profile with a low clearance (CL = 0.229 L/h/kg) and a reasonable oral exposure (AUC0-Last = 5058 ng/mL*h). Most importantly, 14g alleviated the severity of imiquimod-induced psoriasis in mice. Taken together, triazine-based derivatives represent a new chemical class of RORγt inverse agonists as potential therapeutic agents against autoimmune diseases.


Assuntos
Doenças Autoimunes , Receptores do Ácido Retinoico , Camundongos , Animais , Receptores do Ácido Retinoico/agonistas , Membro 3 do Grupo F da Subfamília 1 de Receptores Nucleares/agonistas , Agonismo Inverso de Drogas , Relação Estrutura-Atividade , Doenças Autoimunes/tratamento farmacológico , Triazinas/farmacologia , Triazinas/uso terapêutico
19.
Eur J Med Chem ; 255: 115403, 2023 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-37119666

RESUMO

Bruton's Tyrosine Kinase (BTK) functions as a key regulator of B-cell receptor (BCR) signaling pathway, which is frequently hyperactivated in a variety of lymphoma cancers. Using Proteolysis Targeting Chimera (PROTAC) technology, we have recently discovered a highly potent ARQ-531-derived BTK PROTAC 6e, inducing effective degradation of both wild type (WT) and C481S mutant BTK proteins. However, the poor metabolic stability of PROTAC 6e have limited its further in vivo studies. Herein, we present our structure-activity relationship (SAR) studies on modifying PROTAC 6e using linker rigidification strategy to identify a novel cereblon (CRBN)-recruiting compound 3e that induced BTK degradation in a concentration-dependent manner but had no effect on reducing the level of CRBN neo-substrates. Moreover, compound 3e suppressed the cell growth more potently than the small molecule inhibitors ibrutinib and ARQ-531 in several cells. Furthermore, compound 3e with the rigid linker displayed a significantly improved metabolic stability profile with the T1/2 increased to more than 145 min. Overall, we discovered a highly potent and selective BTK PROTAC lead compound 3e, which could be further optimized as potential BTK degradation therapy for BTK-associated human cancers and diseases.


Assuntos
Quimera de Direcionamento de Proteólise , Pirimidinas , Humanos , Tirosina Quinase da Agamaglobulinemia , Pirimidinas/farmacologia , Pirimidinas/química , Relação Estrutura-Atividade , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/química
20.
Sheng Li Xue Bao ; 75(2): 216-230, 2023 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-37089096

RESUMO

Virtually all of the dietary potassium intake is absorbed in the intestine, over 90% of which is excreted by the kidneys regarded as the most important organ of potassium excretion in the body. The renal excretion of potassium results primarily from the secretion of potassium by the principal cells in the aldosterone-sensitive distal nephron (ASDN), which is coupled to the reabsorption of Na+ by the epithelial Na+ channel (ENaC) located at the apical membrane of principal cells. When Na+ is transferred from the lumen into the cell by ENaC, the negativity in the lumen is relatively increased. K+ efflux, H+ efflux, and Cl- influx are the 3 pathways that respond to Na+ influx, that is, all these 3 pathways are coupled to Na+ influx. In general, Na+ influx is equal to the sum of K+ efflux, H+ efflux, and Cl- influx. Therefore, any alteration in Na+ influx, H+ efflux, or Cl- influx can affect K+ efflux, thereby affecting the renal K+ excretion. Firstly, Na+ influx is affected by the expression level of ENaC, which is mainly regulated by the aldosterone-mineralocorticoid receptor (MR) pathway. ENaC gain-of-function mutations (Liddle syndrome, also known as pseudohyperaldosteronism), MR gain-of-function mutations (Geller syndrome), increased aldosterone levels (primary/secondary hyperaldosteronism), and increased cortisol (Cushing syndrome) or deoxycorticosterone (hypercortisolism) which also activate MR, can lead to up-regulation of ENaC expression, and increased Na+ reabsorption, K+ excretion, as well as H+ excretion, clinically manifested as hypertension, hypokalemia and alkalosis. Conversely, ENaC inactivating mutations (pseudohypoaldosteronism type 1b), MR inactivating mutations (pseudohypoaldosteronism type 1a), or decreased aldosterone levels (hypoaldosteronism) can cause decreased reabsorption of Na+ and decreased excretion of both K+ and H+, clinically manifested as hypotension, hyperkalemia, and acidosis. The ENaC inhibitors amiloride and Triamterene can cause manifestations resembling pseudohypoaldosteronism type 1b; MR antagonist spironolactone causes manifestations similar to pseudohypoaldosteronism type 1a. Secondly, Na+ influx is regulated by the distal delivery of water and sodium. Therefore, when loss-of-function mutations in Na+-K+-2Cl- cotransporter (NKCC) expressed in the thick ascending limb of the loop and in Na+-Cl- cotransporter (NCC) expressed in the distal convoluted tubule (Bartter syndrome and Gitelman syndrome, respectively) occur, the distal delivery of water and sodium increases, followed by an increase in the reabsorption of Na+ by ENaC at the collecting duct, as well as increased excretion of K+ and H+, clinically manifested as hypokalemia and alkalosis. Loop diuretics acting as NKCC inhibitors and thiazide diuretics acting as NCC inhibitors can cause manifestations resembling Bartter syndrome and Gitelman syndrome, respectively. Conversely, when the distal delivery of water and sodium is reduced (e.g., Gordon syndrome, also known as pseudohypoaldosteronism type 2), it is manifested as hypertension, hyperkalemia, and acidosis. Finally, when the distal delivery of non-chloride anions increases (e.g., proximal renal tubular acidosis and congenital chloride-losing diarrhea), the influx of Cl- in the collecting duct decreases; or when the excretion of hydrogen ions by collecting duct intercalated cells is impaired (e.g., distal renal tubular acidosis), the efflux of H+ decreases. Both above conditions can lead to increased K+ secretion and hypokalemia. In this review, we focus on the regulatory mechanisms of renal potassium excretion and the corresponding diseases arising from dysregulation.


Assuntos
Alcalose , Síndrome de Bartter , Síndrome de Gitelman , Hiperpotassemia , Hipertensão , Hipopotassemia , Pseudo-Hipoaldosteronismo , Humanos , Síndrome de Bartter/genética , Síndrome de Bartter/metabolismo , Pseudo-Hipoaldosteronismo/genética , Pseudo-Hipoaldosteronismo/metabolismo , Potássio/metabolismo , Aldosterona/metabolismo , Hipopotassemia/metabolismo , Síndrome de Gitelman/metabolismo , Hiperpotassemia/metabolismo , Relevância Clínica , Canais Epiteliais de Sódio/genética , Canais Epiteliais de Sódio/metabolismo , Túbulos Renais Distais/metabolismo , Sódio/metabolismo , Alcalose/metabolismo , Água/metabolismo , Rim/metabolismo
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