Nonsteroidal Mineralocorticoid Receptor Antagonist Finerenone Improves Diastolic Dysfunction in Preclinical Nondiabetic Chronic Kidney Disease

被引：4

作者：

Lima Posada, Ixchel ^{[3
]}

Soulie, Matthieu ^{[3
,4
]}

Stephan, Yohan ^{[4
]}

Palacios Ramirez, Roberto ^{[3
]}

Bonnard, Benjamin ^{[3
]}

Nicol, Lionel ^{[4
]}

Pitt, Bertram ^{[7
]}

Kolkhof, Peter ^{[5
]}

Mulder, Paul ^{[4
]}

Jaisser, Frederic ^{[1
,2
,3
,6
]}

机构：

[1] Univ Paris, Sorbonne Univ, Ctr Rech Cordeliers, INSERM, F-75006 Paris, France

[2] Univ Paris 06, Ctr Rech Cordeliers, 15 Rue Ecole Med, F-75270 Paris 06, France

[3] Univ Paris Cite, Sorbonne Univ, Ctr Rech Cordeliers, INSERM,UMRS 1138, Paris, France

[4] Univ Rouen Normandie, INSERM, EnVI UMR 1096, Rouen, France

[5] Bayer AG, Cardiovasc Precis Med Res & Early Dev, Pharmaceut, Wuppertal, Germany

[6] Univ Lorraine, Ctr Invest Clin Plurithemat 1433, INSERM, UMR 1116,CHRU Nancy,French Clin Res Infrastruct Ne, Nancy, France

[7] Univ Michigan Med, Dept Med, Ann Arbor, MI USA

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2024年 / 13卷 / 12期

关键词：

5/6; nephrectomy; cardiorenal syndrome; chronic kidney disease; diastolic dysfunction; mineralocorticoid antagonist; HEART-FAILURE; HYPERTROPHY; ACTIVATION; PROTECTS; BENEFIT;

D O I：

10.1161/JAHA.123.032971

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background The mineralocorticoid receptor plays a significant role in the development of chronic kidney disease (CKD) and associated cardiovascular complications. Classic steroidal mineralocorticoid receptor antagonists are a therapeutic option, but their use in the clinic is limited due to the associated risk of hyperkalemia in patients with CKD. Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that has been recently investigated in 2 large phase III clinical trials (FIDELIO-DKD [Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease] and FIGARO-DKD [Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease]), showing reductions in kidney and cardiovascular outcomes.Methods and Results We tested whether finerenone improves renal and cardiac function in a preclinical nondiabetic CKD model. Twelve weeks after 5/6 nephrectomy, the rats showed classic signs of CKD characterized by a reduced glomerular filtration rate and increased kidney weight, associated with left ventricular (LV) diastolic dysfunction and decreased LV perfusion. These changes were associated with increased cardiac fibrosis and reduced endothelial nitric oxide synthase activating phosphorylation (ser 1177). Treatment with finerenone prevented LV diastolic dysfunction and increased LV tissue perfusion associated with a reduction in cardiac fibrosis and increased endothelial nitric oxide synthase phosphorylation. Curative treatment with finerenone improves nondiabetic CKD-related LV diastolic function associated with a reduction in cardiac fibrosis and increased cardiac phosphorylated endothelial nitric oxide synthase independently from changes in kidney function. Short-term finerenone treatment decreased LV end-diastolic pressure volume relationship and increased phosphorylated endothelial nitric oxide synthase and nitric oxide synthase activity.Conclusions We showed that the nonsteroidal mineralocorticoid receptor antagonist finerenone reduces renal hypertrophy and albuminuria, attenuates cardiac diastolic dysfunction and cardiac fibrosis, and improves cardiac perfusion in a preclinical nondiabetic CKD model.

引用

页数：15