ПРОРЕНИН И РЕНИН – НОВЫЕ МИШЕНИ ДЛЯ РЕНО- И КАРДИОПРОТЕКТИВНОЙ ТЕРАПИИ

Имеющиеся на сегодняшний день экспериментальные данные дают основание предполагать, что в условиях блокады ангиотензипревращающего фермента (АПФ) и АТ₁ - рецепторов к ангиотензину II (А-II), проренин и ренин могут проявлять свою профибротическую активность, действуя через специфический проренин/рениновый (П/Р) рецептор. Профибротический эффект проренин/ренина, хотя и обнаружен в основном в почечной ткани, не может считаться изолированным патофизиологическим феноменом и П/Р могут связываться со специфическим рецептором на поверхности кардиомиоцита. В настоящее время проходит клинические испытания новый препарат, единственный представитель группы прямых ингибиторов ренина-алискирен (aliskirеn), недавно одобренный комитетом FDA США в качестве препарата для лечения артериальной гипертензии. Однако до настоящего времени остается неясным вопрос, насколько клинически значимой окажется блокада (про) рениновых рецепторов в отношении развития почечного и сердечного фиброза. Предварительные данные клинических исследований алискирена обнадеживают: уровень микроальбуминурии в ходе его применения снижается на 61% по сравнению с 50% на фоне применения рамиприла. В настоящее время продолжаются два клинических исследования III фазы по оценке эффективности лечения алискиреном больных с хронической болезнью почек (ХБП): AVOID (Aliskiren in the Evaluation of Proteinuria in Diabetes) и AZTITUDE (Aliskiren Trial in Type 2 Diabetic Nephropathy). Результаты этих исследований должны дать новую информацию о влиянии терапии алискиреном на частоту и тяжесть осложнений диабета. Таким образом, открытие новых механизмов функционирования и значения ренин-ангиотензин-альдостероновой системы, по-видимому, в скором будущем создаст новые предпосылки к совершенствованию рено- и кардиопротективной терапии.

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