Mineralocorticoid receptor antagonists, heart failure and predictive biomarkers

Abstract

The mineralocorticoid receptor is a steroid hormone receptor that is well known for its involvement in fluid and electrolyte homeostasis in epithelial cells present in the distal nephron. The inappropriate activation of this receptor is now known to be implicated in various pathophysiological mechanisms in heart failure. Mineralocorticoid receptor antagonists offer substantial clinical benefit in patients with heart failure with reduced ejection fraction, however, for patients with heart failure with preserved ejection fraction, the treatment benefit is less clear. Biomarkers that can predict response to mineralocorticoid receptor antagonist treatment do not currently exist. Potential biomarkers may be modulated either directly by the mineralocorticoid receptor or indirectly via downstream effects and be able to reflect treatment outcomes, particularly changes in key parameters of cardiac health and function. A biomarker or set of biomarkers that can reliably predict responsiveness to mineralocorticoid receptor antagonist treatment at an early stage may allow for the selection of patients who are most likely to benefit from treatment thereby avoiding any unnecessary side effects associated with the use of these medications.

The recent advance and prospect of natural source compounds for the treatment of heart failure

“…The representative MRAs like spironolactone, eplerenone and finerenone etc can block the overactivation of neuroendocrine system in all stages of HF and inhibit the occurrence and development of myocardial remodeling. MRAs can significantly inhibit collagen synthesis and alleviate myocardial fibrosis, which is significantly better than that of angiotensin receptor antagonists ACEIs and ARBs [ 81 ]. In addition, MRAs can regulate the balance of K + and Mg 2+ in myocardium and improve the diastolic and systolic functions to improve myocardial remodeling without affecting the repair of myocardial tissue and scar formation [ 82 ].…”

Terapia farmacológica en insuficiencia cardiaca fracción de eyección reducida: ¿cómo, cuánto, a quién?

“…el receptor de mineralocorticoides es un receptor de hormonas esteroidales nuclear, conocido por su rol a nivel del metabolismo hidroelectrolítico en el nefrón distal, permitiendo una reabsorción de sodio y agua. Además, juega un rol a nivel de varios mecanismos fisiopatológicos de la IC (17) . Estos fármacos, como la espironolactona y la eplerenona, bloquean estos receptores, demostrando un beneficio clínico sustancial (tanto en hospitalización, como mortalidad y calidad de vida) en pacientes con ICFEr (caída hasta 25% en el outcome compuesto de mortalidad y hospitalización) (18)(19)(20) .…”

Аналіз Параметрів Діастолічної Дисфункції Лівого Шлуночка У Хворих На Гіпертонічну Хворобу З Супутнім Цукровим Діабетом 2 Типу

“…У сучасній клінічній практиці частіше зустрічаються пацієнти з коморбідною патологією, що вносить певні складнощі у діагностику та лікування [8][9][10]. Зміни в серцево-судинній системі у діабетичного загалу також можуть викликати розвиток значних порушень в різних органах і системах організму та підсилювати одна одну.…”