Effects of oral antidiabetic agents on the renin-angiotensin-aldosterone system.

IF 2.4 3区 医学 Q3 PHARMACOLOGY & PHARMACY
Xifeng Yang, Yijie Qi, Jinxuan Hao, Hongxia Wei, Zhe Li, Ming Xu, Yi Zhang, Yunfeng Liu
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引用次数: 0

Abstract

Background: The renin-angiotensin-aldosterone system (RAAS) is a vital endocrine system that plays a crucial role in maintaining homeostasis. However, excessive activation of the RAAS can contribute to the pathogenesis of certain diseases. Prolonged hyperglycemia leads to overactivation of the RAAS through the production of inflammatory factors and other mechanisms, ultimately resulting in diabetic complications. Oral antidiabetic agents are the cornerstone of diabetes treatment, and the effects of oral antidiabetic agents on the RAAS have not been clearly summarized.

Objective: To review the effects of various types of oral antidiabetic agents on the components of the RAAS.

Results: Sodium-glucose cotransporter inhibitors (SGLT2i) inhibit glucose and sodium reabsorption, which increases the flow of Na+ to the macula densa, thereby inhibiting tubuloglomerular feedback (TGF) and subsequently decreasing renin production. GLP-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) can directly inhibit angiotensin II (Ang II) or indirectly suppress it by modulating TGF. These agents also affect Ang II type 1 receptors (AT1R) and Ang II type 2 receptors (AT2R) to mitigate Ang II and can indirectly interact with Ang II through Na+/H+ exchanger isotope 3 (NHE3). Thiazolidinediones (TZDs), as PPAR-γ agonists, can enhance the expression of the renin gene, inhibit the production of angiotensin-converting enzyme (ACE), regulate the levels of AT1R and AT2R, and decrease aldosterone production. Metformin also inhibits the production of renin and aldosterone in patients with polycystic ovary syndrome (PCOS).

Conclusions: These oral agents, which exhibit diverse effects on the components of the RAAS, modulate the activity of these components to exert antihypertensive, anti-inflammatory, cardioprotective, and renoprotective effects, thereby offering several beneficial outcomes in the management of diabetes.

口服降糖药对肾素-血管紧张素-醛固酮系统的影响。
背景:肾素-血管紧张素-醛固酮系统(RAAS)是一个重要的内分泌系统,在维持体内平衡中起重要作用。然而,过度激活的RAAS可以促进某些疾病的发病机制。长期高血糖通过产生炎症因子等机制导致RAAS过度激活,最终导致糖尿病并发症。口服降糖药是糖尿病治疗的基石,目前口服降糖药对RAAS的影响尚未得到明确的总结。目的:探讨不同类型口服降糖药对RAAS成分的影响。结果:钠-葡萄糖共转运蛋白抑制剂(SGLT2i)抑制葡萄糖和钠的重吸收,增加Na+向黄斑致密的流动,从而抑制小管肾小球反馈(TGF),从而减少肾素的产生。GLP-1受体激动剂(GLP-1RA)和二肽基肽酶-4抑制剂(DPP-4i)可直接抑制血管紧张素II (Ang II)或通过调节TGF间接抑制。这些药物还可以作用于Ang II型1受体(AT1R)和Ang II型2受体(AT2R)以减轻Ang II,并通过Na+/H+交换同位素3 (NHE3)间接与Ang II相互作用。噻唑烷二酮类(TZDs)作为PPAR-γ激动剂,可以增强肾素基因的表达,抑制血管紧张素转换酶(ACE)的产生,调节AT1R和AT2R的水平,降低醛固酮的产生。二甲双胍还能抑制多囊卵巢综合征(PCOS)患者肾素和醛固酮的产生。结论:这些口服药物对RAAS的成分有不同的作用,通过调节这些成分的活性来发挥降压、抗炎、保护心脏和保护肾脏的作用,从而在糖尿病的治疗中提供了一些有益的结果。
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来源期刊
CiteScore
5.40
自引率
3.40%
发文量
170
审稿时长
3-8 weeks
期刊介绍: The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed. Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor. Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves -a compound that is interesting and new in some basic or fundamental way, or -methods that are original in some basic sense, or -a highly unexpected outcome, or -conclusions that are scientifically novel in some basic or fundamental sense.
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