正常血压和先兆子痫妊娠期间(前)肾素受体在激活肾素-血管紧张素系统中的重要性。

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Current Hypertension Reports Pub Date : 2024-12-01 Epub Date: 2024-08-02 DOI:10.1007/s11906-024-01316-1
Lachlan G Schofield, Saije K Endacott, Sarah J Delforce, Eugenie R Lumbers, Kirsty G Pringle
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引用次数: 0

摘要

审查目的:健康妊娠的发生需要母体循环肾素-血管紧张素-醛固酮系统(RAAS)、胎盘肾素-血管紧张素系统(RAS)和肾内肾素-血管紧张素系统(iRAS)之间有控制的相互作用。在功能上,肾上腺素-血管紧张素系统和肾内肾素-血管紧张素系统相互作用,以维持血压和心输出量以及体液和电解质平衡。胎盘 RAS 对胎盘发育很重要,同时也影响母体循环中的 RAAS 和 iRAS。这篇叙述性综述集中探讨了(原)肾素受体((P)RR)及其可溶性形式(s(P)RR)与妊娠高血压病理--子痫前期--的关系:最近的研究结果:(P)RR 和 s(P)RR 不仅能激活肾素原和肾素,从而影响血管紧张素 II(Ang II)的水平,而且 s(P)RR 还能直接与血管紧张素 II 1 型受体(AT1R)相互作用并刺激血管紧张素 II 1 型受体,因此特别受到关注。子痫前期患者的胎盘(P)RR 和母体循环中的 s(P)RR 水平都会升高。此外,在非妊娠和妊娠大鼠和小鼠体内,s(P)RR 也被证明会升高血压。在以母体高血压和胎盘发育及功能受损为特征的子痫前期妊娠中,我们认为 s(P)RR 从胎盘进入母体循环的分泌量会增加。由于s(P)RR既能激活促肾素,又能作为AT1R激动剂,过量的母体循环s(P)RR既能作用于母体血管,也能作用于肾脏,导致RAS过度激活。这会导致母体循环 RAAS 失调和 iRAS 过度激活,从而引起母体高血压、肾损伤以及继发性体液和电解质平衡的神经体液调节变化,最终导致子痫前期的病理生理学。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Importance of the (Pro)renin Receptor in Activating the Renin-Angiotensin System During Normotensive and Preeclamptic Pregnancies.

Importance of the (Pro)renin Receptor in Activating the Renin-Angiotensin System During Normotensive and Preeclamptic Pregnancies.

Purpose of review: For a healthy pregnancy to occur, a controlled interplay between the maternal circulating renin-angiotensin-aldosterone system (RAAS), placental renin-angiotensin system (RAS) and intrarenal renin-angiotensin system (iRAS) is necessary. Functionally, both the RAAS and iRAS interact to maintain blood pressure and cardiac output, as well as fluid and electrolyte balance. The placental RAS is important for placental development while also influencing the maternal circulating RAAS and iRAS. This narrative review concentrates on the (pro)renin receptor ((P)RR) and its soluble form (s(P)RR) in the context of the hypertensive pregnancy pathology, preeclampsia.

Recent findings: The (P)RR and the s(P)RR have become of particular interest as not only can they activate prorenin and renin, thus influencing levels of angiotensin II (Ang II), but s(P)RR has now been shown to directly interact with and stimulate the Angiotensin II type 1 receptor (AT1R). Levels of both placental (P)RR and maternal circulating s(P)RR are elevated in patients with preeclampsia. Furthermore, s(P)RR has been shown to increase blood pressure in non-pregnant and pregnant rats and mice. In preeclamptic pregnancies, which are characterised by maternal hypertension and impaired placental development and function, we propose that there is enhanced secretion of s(P)RR from the placenta into the maternal circulation. Due to its ability to both activate prorenin and act as an AT1R agonist, excess maternal circulating s(P)RR can act on both the maternal vasculature, and the kidney, leading to RAS over-activation. This results in dysregulation of the maternal circulating RAAS and overactivation of the iRAS, contributing to maternal hypertension, renal damage, and secondary changes to neurohumoral regulation of fluid and electrolyte balance, ultimately contributing to the pathophysiology of preeclampsia.

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来源期刊
Current Hypertension Reports
Current Hypertension Reports 医学-外周血管病
CiteScore
10.50
自引率
0.00%
发文量
65
审稿时长
6-12 weeks
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of hypertension. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antihypertensive therapies, associated metabolic disorders, and therapeutic trials. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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