ПРОРЕНИН И РЕНИН – НОВЫЕ МИШЕНИ ДЛЯ РЕНО- И КАРДИОПРОТЕКТИВНОЙ ТЕРАПИИ
Аннотация
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.
Ключевые слова
Об авторах
А. В. Смирнов
Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова
Россия
Россия
Научно-исследовательский институт нефрологии
197022 Санкт-Петербург, ул. Л. Толстого 17, НИИ Нефрологии СПбГМУ им. акад. И.П. Павлова; тел.: (812)-234-01-65
К. А. Смирнов
Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова
Россия
Россия
Научно-исследовательский институт нефрологии
197022 Санкт-Петербург, ул. Л. Толстого 17
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Рецензия
Для цитирования:
Смирнов А.В., Смирнов К.А. ПРОРЕНИН И РЕНИН – НОВЫЕ МИШЕНИ ДЛЯ РЕНО- И КАРДИОПРОТЕКТИВНОЙ ТЕРАПИИ. Нефрология. 2009;13(1):15-20. https://doi.org/10.24884/1561-6274-2009-13-1-15-20
For citation:
Smirnov A.V., Smirnov K.A. PRORENIN AND RENIN – NEW TARGETS FOR RENO- AND CARDIOPROTECTIVE THERAPY. Nephrology (Saint-Petersburg). 2009;13(1):15-20. (In Russ.) https://doi.org/10.24884/1561-6274-2009-13-1-15-20
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