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Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks. 治疗原发性醛固酮增多症诱发的高血压:新方法与未来展望。
IF 20.3 1区 医学 Q1 Medicine Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad026
Nathan Mullen, James Curneen, Padraig T Donlon, Punit Prakash, Irina Bancos, Mark Gurnell, Michael C Dennedy

Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with increased morbidity and mortality when compared with blood pressure-matched cases of primary hypertension. Current limitations in patient care stem from delayed recognition of the condition, limited access to key diagnostic procedures, and lack of a definitive therapy option for nonsurgical candidates. However, several recent advances have the potential to address these barriers to optimal care. From a diagnostic perspective, machine-learning algorithms have shown promise in the prediction of PA subtypes, while the development of noninvasive alternatives to adrenal vein sampling (including molecular positron emission tomography imaging) has made accurate localization of functioning adrenal nodules possible. In parallel, more selective approaches to targeting the causative aldosterone-producing adrenal adenoma/nodule (APA/APN) have emerged with the advent of partial adrenalectomy or precision ablation. Additionally, the development of novel pharmacological agents may help to mitigate off-target effects of aldosterone and improve clinical efficacy and outcomes. Here, we consider how each of these innovations might change our approach to the patient with PA, to allow more tailored investigation and treatment plans, with corresponding improvement in clinical outcomes and resource utilization, for this highly prevalent disorder.

原发性醛固酮增多症(PA)是继发性高血压最常见的病因,与血压匹配的原发性高血压病例相比,其发病率和死亡率均有所上升。目前患者治疗的局限性在于对病情的认识不及时、获得关键诊断程序的途径有限,以及缺乏针对非手术候选者的明确治疗方案。然而,最近取得的几项进展有可能消除这些障碍,实现最佳治疗。从诊断的角度来看,机器学习算法已在预测 PA 亚型方面显示出前景,而肾上腺静脉取样的无创替代方法(包括分子正电子发射断层成像)的开发已使功能性肾上腺结节的精确定位成为可能。与此同时,随着肾上腺部分切除术或精确消融术的出现,针对致病性醛固酮分泌型肾上腺腺瘤/结节(APA/APN)的选择性更强。此外,新型药理制剂的开发可能有助于减轻醛固酮的脱靶效应,改善临床疗效和预后。在此,我们将探讨这些创新如何改变我们对 PA 患者的治疗方法,从而为这种高发疾病提供更有针对性的检查和治疗方案,并相应改善临床疗效和资源利用率。
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引用次数: 0
Biomarkers to Guide Medical Therapy in Primary Aldosteronism. 指导原发性醛固酮增多症药物治疗的生物标志物。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad024
Gregory L Hundemer, Alexander A Leung, Gregory A Kline, Jenifer M Brown, Adina F Turcu, Anand Vaidya

Primary aldosteronism (PA) is an endocrinopathy characterized by dysregulated aldosterone production that occurs despite suppression of renin and angiotensin II, and that is non-suppressible by volume and sodium loading. The effectiveness of surgical adrenalectomy for patients with lateralizing PA is characterized by the attenuation of excess aldosterone production leading to blood pressure reduction, correction of hypokalemia, and increases in renin-biomarkers that collectively indicate a reversal of PA pathophysiology and restoration of normal physiology. Even though the vast majority of patients with PA will ultimately be treated medically rather than surgically, there is a lack of guidance on how to optimize medical therapy and on key metrics of success. Herein, we review the evidence justifying approaches to medical management of PA and biomarkers that reflect endocrine principles of restoring normal physiology. We review the current arsenal of medical therapies, including dietary sodium restriction, steroidal and nonsteroidal mineralocorticoid receptor antagonists, epithelial sodium channel inhibitors, and aldosterone synthase inhibitors. It is crucial that clinicians recognize that multimodal medical treatment for PA can be highly effective at reducing the risk for adverse cardiovascular and kidney outcomes when titrated with intention. The key biomarkers reflective of optimized medical therapy are unsurprisingly similar to the physiologic expectations following surgical adrenalectomy: control of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium without supplementation, and a rise in renin. Pragmatic approaches to achieve these objectives while mitigating adverse effects are reviewed.

原发性醛固酮增多症(PA)是一种以醛固酮分泌失调为特征的内分泌疾病,尽管肾素和血管紧张素II受到抑制,但仍会发生,并且不受容量和钠负荷的抑制。手术切除肾上腺对侧化PA患者的有效性表现为减少过量醛固酮产生导致血压降低、纠正低钾血症和肾素升高;这些生物标志物共同表明PA病理生理的逆转和正常生理的恢复。尽管绝大多数PA患者最终将接受药物治疗而不是手术治疗,但缺乏关于如何优化药物治疗和成功的关键指标的指导。在此,我们回顾了证明PA医学管理方法和生物标志物的证据,这些生物标志物反映了恢复正常生理的内分泌原理。我们回顾了目前的医学治疗方法,包括饮食钠限制,甾体和非甾体矿物皮质激素受体拮抗剂,上皮钠通道抑制剂和醛固酮合成酶抑制剂。至关重要的是,临床医生认识到,当有意滴定时,PA的多模式医学治疗可以非常有效地降低心血管和肾脏不良后果的风险。反映优化药物治疗的关键生物标志物与肾上腺切除术后的生理预期相似:使用最少数量的降压药控制血压,无需补充血清钾正常化,肾素升高。审查了在减轻不利影响的同时实现这些目标的务实方法。
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引用次数: 0
Radiation-Related Thyroid Cancer. 与辐射相关的甲状腺癌
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad022
Vladimir Saenko, Norisato Mitsutake

Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plant accidents are described, summarizing the information on thyroid cancer epidemiology, treatment, and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers have evolved in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the 2 areas reveals numerous differences that cumulatively suggest the low probability of the radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For external exposures, reasonable measures are generally in line with the As Low As Reasonably Achievable principle, while for internal irradiation from radioactive iodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.

辐射是一种会增加甲状腺癌发病风险的环境因素。外部和内部辐射的实际和可能情况多种多样。本文回顾了甲状腺所受的辐射剂量以及计划中、现有和紧急辐照情况下的相应癌症风险,以及医疗、公共和职业类别的辐照。任何辐照情况都可能对甲状腺造成一定范围的剂量,本文将讨论癌症风险以及影响因素。文章描述了切尔诺贝利核电站事故和福岛核电站事故的后果,总结了甲状腺癌流行病学、治疗和预后、临床病理学特征和基因改变方面的信息。切尔诺贝利事故中的甲状腺癌随着时间的推移发生了演变:侵袭性减弱,驱动因素从融合转变为点突变。对两个地区的甲状腺癌进行比较后发现了许多差异,这些差异累积起来表明,福岛地区甲状腺癌的放射源性质可能性很低。鉴于在各种环境中持续使用不同的辐射源,我们考虑了降低辐照导致甲状腺癌风险的可能方法。对于外部辐照,合理的措施一般符合 "尽可能低 "原则,而对于放射性碘的内部辐照,在预计会发生核反应堆事故的情况下,除其他措施外,可能建议使用稳定碘进行甲状腺阻断。最后,从流行病学、基础科学和临床角度讨论了辐射对甲状腺影响的研究前景。
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引用次数: 0
Crosstalk Between the Neuroendocrine System and Bone Homeostasis. 神经内分泌系统与骨平衡之间的相互关系
IF 20.3 1区 医学 Q1 Medicine Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad025
Yuhu Zhao, Xiaole Peng, Qing Wang, Zhiyu Zhang, Liangliang Wang, Yaozeng Xu, Huilin Yang, Jiaxiang Bai, Dechun Geng

The homeostasis of bone microenvironment is the foundation of bone health and comprises 2 concerted events: bone formation by osteoblasts and bone resorption by osteoclasts. In the early 21st century, leptin, an adipocytes-derived hormone, was found to affect bone homeostasis through hypothalamic relay and the sympathetic nervous system, involving neurotransmitters like serotonin and norepinephrine. This discovery has provided a new perspective regarding the synergistic effects of endocrine and nervous systems on skeletal homeostasis. Since then, more studies have been conducted, gradually uncovering the complex neuroendocrine regulation underlying bone homeostasis. Intriguingly, bone is also considered as an endocrine organ that can produce regulatory factors that in turn exert effects on neuroendocrine activities. After decades of exploration into bone regulation mechanisms, separate bioactive factors have been extensively investigated, whereas few studies have systematically shown a global view of bone homeostasis regulation. Therefore, we summarized the previously studied regulatory patterns from the nervous system and endocrine system to bone. This review will provide readers with a panoramic view of the intimate relationship between the neuroendocrine system and bone, compensating for the current understanding of the regulation patterns of bone homeostasis, and probably developing new therapeutic strategies for its related disorders.

骨骼微环境的平衡是骨骼健康的基础,它包括两个协同事件:成骨细胞的骨形成和破骨细胞的骨吸收。21 世纪初,人们发现瘦素(一种源自脂肪细胞的激素)可通过下丘脑中继和交感神经系统影响骨平衡,其中涉及血清素和去甲肾上腺素等神经递质。这一发现为内分泌和神经系统对骨骼稳态的协同作用提供了新的视角。此后,更多的研究逐渐揭示了骨平衡背后复杂的神经内分泌调控。耐人寻味的是,骨骼也被认为是一种内分泌器官,可以产生调节因子,进而对神经内分泌活动产生影响。经过几十年对骨调节机制的探索,单独的生物活性因子已被广泛研究,但很少有研究系统地展示了骨稳态调节的全貌。因此,我们总结了之前研究的从神经系统和内分泌系统到骨骼的调控模式。这篇综述将为读者提供一个神经内分泌系统与骨之间密切关系的全景视角,弥补目前对骨稳态调控模式的认识不足,并可能为其相关疾病开发出新的治疗策略。
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引用次数: 0
The Pregnancy-Associated Plasma Protein-A (PAPP-A) Story. 妊娠相关血浆蛋白a (pap - a)的故事。
IF 20.3 1区 医学 Q1 Medicine Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad017
Cheryl A Conover, Claus Oxvig

Pregnancy-associated plasma protein-A (PAPP-A) was first identified in the early 1970s as a placental protein of unknown function, present at high concentrations in the circulation of pregnant women. In the mid-to-late 1990s, PAPP-A was discovered to be a metzincin metalloproteinase, expressed by many nonplacental cells, that regulates local insulin-like growth factor (IGF) activity through cleavage of high-affinity IGF binding proteins (IGFBPs), in particular IGFBP-4. With PAPP-A as a cell surface-associated enzyme, the reduced affinity of the cleavage fragments results in increased IGF available to bind and activate IGF receptors in the pericellular environment. This proteolytic regulation of IGF activity is important, since the IGFs promote proliferation, differentiation, migration, and survival in various normal and cancer cells. Thus, there has been a steady growth in investigation of PAPP-A structure and function outside of pregnancy. This review provides historical perspective on the discovery of PAPP-A and its structure and cellular function, highlights key studies of the first 50 years in PAPP-A research, and introduces new findings from recent years.

妊娠相关血浆蛋白-a (PAPP-A)在20世纪70年代初首次被发现是一种功能未知的胎盘蛋白,高浓度存在于孕妇的血液循环中。在20世纪90年代中后期,PAPP-A被发现是一种由许多非胎盘细胞表达的metzincin金属蛋白酶,通过切割高亲和力的IGF结合蛋白(igfbp),特别是IGFBP-4,来调节局部胰岛素样生长因子(IGF)的活性。由于PAPP-A是一种细胞表面相关酶,切割片段的亲和力降低导致可结合并激活细胞周围环境中IGF受体的IGF增加。IGF活性的蛋白水解调节是重要的,因为IGF促进各种正常细胞和癌细胞的增殖、分化、迁移和存活。因此,对妊娠期外ppap - a结构和功能的研究稳步增长。本文综述了PAPP-A的发现历史及其结构和细胞功能,重点介绍了前50年PAPP-A研究的重点研究,并介绍了近年来的新发现。
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引用次数: 3
Update on Adipose Tissue and Cancer. 脂肪组织与癌症的最新进展。
IF 20.3 1区 医学 Q1 Medicine Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad015
Kristy A Brown, Philipp E Scherer

Adipose tissue is the largest endocrine organ and an accepted contributor to overall energy homeostasis. There is strong evidence linking increased adiposity to the development of 13 types of cancer. With increased adiposity comes metabolic dysfunction and insulin resistance, and increased systemic insulin and glucose support the growth of many cancers, including those of the colon and endometrium. There is also an important direct crosstalk between adipose tissue and various organs. For instance, the healthy development and function of the mammary gland, as well as the development, growth, and progression of breast cancer, are heavily impacted by the breast adipose tissue in which breast epithelial cells are embedded. Cells of the adipose tissue are responsive to external stimuli, including overfeeding, leading to remodeling and important changes in the secretion of factors known to drive the development and growth of cancers. Loss of factors like adiponectin and increased production of leptin, endotrophin, steroid hormones, and inflammatory mediators have been determined to be important mediators of the obesity-cancer link. Obesity is also associated with a structural remodeling of the adipose tissue, including increased localized fibrosis and disrupted angiogenesis that contribute to the development and progression of cancers. Furthermore, tumor cells feed off the adipose tissue, where increased lipolysis within adipocytes leads to the release of fatty acids and stromal cell aerobic glycolysis leading to the increased production of lactate. Both have been hypothesized to support the higher energetic demands of cancer cells. Here, we aim to provide an update on the state of the literature revolving around the role of the adipose tissue in cancer initiation and progression.

脂肪组织是最大的内分泌器官,也是公认的整体能量稳态的贡献者。有强有力的证据表明,肥胖的增加与13种癌症的发展有关。随着肥胖的增加,代谢功能障碍和胰岛素抵抗也随之而来,全身胰岛素和葡萄糖的增加支持了许多癌症的生长,包括结肠癌和子宫内膜癌。脂肪组织与各器官之间也存在着重要的直接串扰。例如,乳腺的健康发育和功能,以及乳腺癌的发展、生长和进展,都受到乳腺上皮细胞所在的乳腺脂肪组织的严重影响。脂肪组织的细胞对外部刺激(包括过度进食)有反应,导致重塑和已知驱动癌症发展和生长的因子分泌的重要变化。脂联素等因子的丧失和瘦素、内源性营养因子、类固醇激素和炎症介质的产生增加已被确定为肥胖-癌症关联的重要介质。肥胖还与脂肪组织的结构重塑有关,包括局部纤维化增加和血管生成中断,这些都有助于癌症的发生和进展。此外,肿瘤细胞以脂肪组织为食,脂肪细胞内增加的脂肪分解导致脂肪酸的释放,基质细胞有氧糖酵解导致乳酸的产生增加。两者都被假设为支持癌细胞更高的能量需求。在这里,我们的目标是提供关于脂肪组织在癌症发生和发展中的作用的最新文献。
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引用次数: 0
Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics. 子宫内膜异位症的表观遗传失调:病理生理学和治疗的意义。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad020
Ryan M Marquardt, Dinh Nam Tran, Bruce A Lessey, Md Saidur Rahman, Jae-Wook Jeong

Endometriosis is a prevalent gynecological condition associated with pelvic pain and infertility. Despite more than a century of research, the etiology of endometriosis still eludes scientific consensus. This lack of clarity has resulted in suboptimal prevention, diagnosis, and treatment options. Evidence of genetic contributors to endometriosis is interesting but limited; however, significant progress has been made in recent years in identifying an epigenetic role in the pathogenesis of endometriosis through clinical studies, in vitro cell culture experiments, and in vivo animal models. The predominant findings include endometriosis-related differential expression of DNA methyltransferases and demethylases, histone deacetylases, methyltransferases, and demethylases, and regulators of chromatin architecture. There is also an emerging role for miRNAs in controlling epigenetic regulators in the endometrium and endometriosis. Changes in these epigenetic regulators result in differential chromatin organization and DNA methylation, with consequences for gene expression independent of a genetic sequence. Epigenetically altered expression of genes related to steroid hormone production and signaling, immune regulation, and endometrial cell identity and function have all been identified and appear to play into the pathophysiological mechanisms of endometriosis and resulting infertility. This review summarizes and critically discusses early seminal findings, the ever-growing recent evidence of epigenetic contributions to the pathophysiology of endometriosis, and implications for proposed epigenetically targeted therapeutics.

子宫内膜异位症是一种常见的妇科疾病,与盆腔疼痛和不孕有关。尽管经过了一个多世纪的研究,子宫内膜异位症的病因仍未达成科学共识。由于缺乏明确性,导致预防、诊断和治疗选择不够理想。子宫内膜异位症的遗传因素的证据很有趣,但有限;然而,近年来,通过临床研究、体外细胞培养实验和体内动物模型,在确定表观遗传学在子宫内膜异位症发病机制中的作用方面取得了重大进展。主要发现包括子宫内膜异位症相关的DNA甲基转移酶和去甲基化酶、组蛋白去乙酰化酶、甲基转移酶和去甲基化酶以及染色质结构调节因子的差异表达。mirna在控制子宫内膜和子宫内膜异位症的表观遗传调节因子方面也有新的作用。这些表观遗传调节因子的变化导致不同的染色质组织和DNA甲基化,其结果是独立于基因序列的基因表达。与类固醇激素产生和信号、免疫调节、子宫内膜细胞身份和功能相关的基因的表观遗传表达改变都已被确定,并似乎在子宫内膜异位症和导致不孕的病理生理机制中发挥作用。这篇综述总结并批判性地讨论了早期的精液发现,最近越来越多的证据表明表观遗传学对子宫内膜异位症的病理生理有贡献,以及对拟议的表观遗传学靶向治疗的影响。
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引用次数: 0
The Hypothalamus-pituitary-adrenocortical Response to Critical Illness: A Concept in Need of Revision. 下丘脑-垂体-肾上腺皮质对危重疾病的反应:一个需要修正的概念。
IF 20.3 1区 医学 Q1 Medicine Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad021
Lies Langouche, Arno Téblick, Jan Gunst, Greet Van den Berghe

Based on insights obtained during the past decade, the classical concept of an activated hypothalamus-pituitary-adrenocortical axis in response to critical illness is in need of revision. After a brief central hypothalamus-pituitary-adrenocortical axis activation, the vital maintenance of increased systemic cortisol availability and action in response to critical illness is predominantly driven by peripheral adaptations rather than by an ongoing centrally activated several-fold increased production and secretion of cortisol. Besides the known reduction of cortisol-binding proteins that increases free cortisol, these peripheral responses comprise suppressed cortisol metabolism in liver and kidney, prolonging cortisol half-life, and local alterations in expression of 11βHSD1, glucocorticoid receptor-α (GRα), and FK506 binding protein 5 (FKBP51) that appear to titrate increased GRα action in vital organs and tissues while reducing GRα action in neutrophils, possibly preventing immune-suppressive off-target effects of increased systemic cortisol availability. Peripherally increased cortisol exerts negative feed-back inhibition at the pituitary level impairing processing of pro-opiomelanocortin into ACTH, thereby reducing ACTH-driven cortisol secretion, whereas ongoing central activation results in increased circulating pro-opiomelanocortin. These alterations seem adaptive and beneficial for the host in the short term. However, as a consequence, patients with prolonged critical illness who require intensive care for weeks or longer may develop a form of central adrenal insufficiency. The new findings supersede earlier concepts such as "relative," as opposed to "absolute," adrenal insufficiency and generalized systemic glucocorticoid resistance in the critically ill. The findings also question the scientific basis for broad implementation of stress dose hydrocortisone treatment of patients suffering from acute septic shock solely based on assumption of cortisol insufficiency.

基于过去十年获得的见解,对危重疾病反应的激活下丘脑-垂体-肾上腺皮质轴的经典概念需要修订。在短暂的中枢下丘脑-垂体-肾上腺皮质轴激活后,增加的全身皮质醇可用性和对危重疾病的反应的重要维持主要是由外周适应驱动的,而不是由持续的中央激活的几倍增加的皮质醇的产生和分泌驱动的。除了已知的增加游离皮质醇的皮质醇结合蛋白的减少外,这些外周反应还包括肝脏和肾脏中皮质醇代谢的抑制,皮质醇半衰期的延长,以及11βHSD1、糖皮质激素受体-α (GRα)和FK506结合蛋白5 (FKBP51)表达的局部改变,这些表达似乎会增加重要器官和组织中GRα的作用,同时降低中性粒细胞中GRα的作用。可能防止免疫抑制脱靶效应增加全身皮质醇可用性。外周升高的皮质醇在垂体水平上产生负反馈抑制,损害促肾上腺皮质激素的加工过程,从而减少促肾上腺皮质激素驱动的皮质醇分泌,而持续的中枢激活导致循环促肾上腺皮质激素的增加。这些变化似乎是适应性的,在短期内对宿主有益。然而,结果是,需要重症监护数周或更长时间的重症患者可能会出现中枢性肾上腺功能不全。新发现取代了早期的概念,如“相对”,而不是“绝对”,肾上腺功能不全和危重患者全身糖皮质激素抵抗。研究结果还质疑了仅仅基于皮质醇不足假设而广泛实施应激剂量氢化可的松治疗急性感染性休克患者的科学依据。
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引用次数: 0
Nicotinamide Adenine Dinucleotide in Aging Biology: Potential Applications and Many Unknowns. 烟酰胺腺嘌呤二核苷酸在衰老生物学中的潜在应用和许多未知。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad019
Shalender Bhasin, Douglas Seals, Marie Migaud, Nicolas Musi, Joseph A Baur

Recent research has unveiled an expansive role of NAD+ in cellular energy generation, redox reactions, and as a substrate or cosubstrate in signaling pathways that regulate health span and aging. This review provides a critical appraisal of the clinical pharmacology and the preclinical and clinical evidence for therapeutic effects of NAD+ precursors for age-related conditions, with a particular focus on cardiometabolic disorders, and discusses gaps in current knowledge. NAD+ levels decrease throughout life; age-related decline in NAD+ bioavailability has been postulated to be a contributor to many age-related diseases. Raising NAD+ levels in model organisms by administration of NAD+ precursors improves glucose and lipid metabolism; attenuates diet-induced weight gain, diabetes, diabetic kidney disease, and hepatic steatosis; reduces endothelial dysfunction; protects heart from ischemic injury; improves left ventricular function in models of heart failure; attenuates cerebrovascular and neurodegenerative disorders; and increases health span. Early human studies show that NAD+ levels can be raised safely in blood and some tissues by oral NAD+ precursors and suggest benefit in preventing nonmelanotic skin cancer, modestly reducing blood pressure and improving lipid profile in older adults with obesity or overweight; preventing kidney injury in at-risk patients; and suppressing inflammation in Parkinson disease and SARS-CoV-2 infection. Clinical pharmacology, metabolism, and therapeutic mechanisms of NAD+ precursors remain incompletely understood. We suggest that these early findings provide the rationale for adequately powered randomized trials to evaluate the efficacy of NAD+ augmentation as a therapeutic strategy to prevent and treat metabolic disorders and age-related conditions.

最近的研究揭示了NAD+在细胞能量生成、氧化还原反应中的广泛作用,并在调节健康寿命和衰老的信号通路中作为底物或共底物。本综述对NAD+前体治疗年龄相关疾病的临床药理学、临床前和临床证据进行了批判性评估,特别关注心脏代谢疾病,并讨论了当前知识的空白。NAD+水平在整个生命过程中下降;年龄相关的NAD+生物利用度下降被认为是许多年龄相关疾病的一个因素。通过给药NAD+前体提高模式生物的NAD+水平可改善糖脂代谢;减轻饮食引起的体重增加、糖尿病、糖尿病肾病和肝脂肪变性;减少内皮功能障碍;保护心脏免受缺血性损伤;改善心力衰竭模型左心室功能;减轻脑血管和神经退行性疾病;延长了健康寿命。早期的人体研究表明,口服NAD+前体可以安全地提高血液和某些组织中的NAD+水平,并表明在预防非黑色素皮肤癌、适度降低血压和改善肥胖或超重老年人的血脂水平方面有好处;预防高危患者肾损伤;抑制帕金森病和SARS-CoV-2感染的炎症。NAD+前体的临床药理学、代谢和治疗机制仍不完全清楚。我们认为,这些早期发现为充分有力的随机试验提供了理论依据,以评估NAD+增强作为预防和治疗代谢紊乱和年龄相关疾病的治疗策略的有效性。
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引用次数: 0
Treating the Side Effects of Exogenous Glucocorticoids; Can We Separate the Good From the Bad? 外源性糖皮质激素不良反应的治疗我们能区分好与坏吗?
IF 20.3 1区 医学 Q1 Medicine Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad016
Riccardo Pofi, Giorgio Caratti, David W Ray, Jeremy W Tomlinson

It is estimated that 2% to 3% of the population are currently prescribed systemic or topical glucocorticoid treatment. The potent anti-inflammatory action of glucocorticoids to deliver therapeutic benefit is not in doubt. However, the side effects associated with their use, including central weight gain, hypertension, insulin resistance, type 2 diabetes (T2D), and osteoporosis, often collectively termed iatrogenic Cushing's syndrome, are associated with a significant health and economic burden. The precise cellular mechanisms underpinning the differential action of glucocorticoids to drive the desirable and undesirable effects are still not completely understood. Faced with the unmet clinical need to limit glucocorticoid-induced adverse effects alongside ensuring the preservation of anti-inflammatory actions, several strategies have been pursued. The coprescription of existing licensed drugs to treat incident adverse effects can be effective, but data examining the prevention of adverse effects are limited. Novel selective glucocorticoid receptor agonists and selective glucocorticoid receptor modulators have been designed that aim to specifically and selectively activate anti-inflammatory responses based upon their interaction with the glucocorticoid receptor. Several of these compounds are currently in clinical trials to evaluate their efficacy. More recently, strategies exploiting tissue-specific glucocorticoid metabolism through the isoforms of 11β-hydroxysteroid dehydrogenase has shown early potential, although data from clinical trials are limited. The aim of any treatment is to maximize benefit while minimizing risk, and within this review we define the adverse effect profile associated with glucocorticoid use and evaluate current and developing strategies that aim to limit side effects but preserve desirable therapeutic efficacy.

据估计,目前有2%至3%的人接受全身或局部糖皮质激素治疗。糖皮质激素的有效抗炎作用提供治疗效益是毫无疑问的。然而,与它们的使用相关的副作用,包括中心体重增加、高血压、胰岛素抵抗、2型糖尿病(T2D)和骨质疏松症,通常统称为医源性库欣综合征,与重大的健康和经济负担相关。支持糖皮质激素驱动理想和不理想效果的不同作用的精确细胞机制仍未完全了解。面对未满足的临床需求,限制糖皮质激素诱导的不良反应,同时确保保持抗炎作用,已经采取了几种策略。现有许可药物的共同处方治疗偶发不良反应可能有效,但检查预防不良反应的数据有限。新的选择性糖皮质激素受体激动剂和选择性糖皮质激素受体调节剂已经被设计出来,目的是特异性和选择性地激活基于它们与糖皮质激素受体相互作用的抗炎反应。其中一些化合物目前正在进行临床试验,以评估其疗效。最近,通过11β-羟基类固醇脱氢酶的同工型来开发组织特异性糖皮质激素代谢的策略已经显示出早期的潜力,尽管来自临床试验的数据有限。任何治疗的目标都是在最小化风险的同时最大化获益,在本综述中,我们定义了与糖皮质激素使用相关的不良反应概况,并评估了当前和正在开发的旨在限制副作用但保持理想治疗效果的策略。
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Endocrine reviews
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