Therapeutic Targets for Heart Failure:Beyond Beta-adrenergic Receptor Blockade

来源 :中国上海第七届国际新药发明科技年会 | 被引量 : 0次 | 上传用户:kuibugo
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  Prolonged activation of sympathetic nerve activity is a hallmark of the pathogenesis of chronic heart failure.Current guide lines for the management of chronic heart failure recommend the suppression of sympathetic nerve activity at the level of the beta-adrenergic receptor and/or the rennin-angiotensin system.Suppression of beta-adrenergic receptor activity by beta-blockers leads to decreased activity of adenylyl cyclase,the effecter enzyme of the beta-adrenergic receptor,thereby decreases the production of cAMP,an important second messenger to regulate cardiac sympathetic activity.Because beta-adrenergic receptors are composed of three subtypes that show relatively poor tissue specificity,use of beta-blockers is contraindicated,for example,in patients with lung diseases.Adenylyl cyclase,in contrast,has nine isoforms that show distinct tissue specificity.In particular,the heart expresses type 5 adenylyl cyclase as the major isoform.Mouse with deficient expression of this isoform showed preserved basal cardiac function while they showed increased protection against various stresses,such as pressure overload or chronic catecholamine infusion,and demonstrated increased longevity.Pharmacological compounds have been developed to regulate the activity of adenylyl cyclase in an isoform dependent manner.These findings suggest the development of new strategies,beyond the current beta-adrenergic receptor blockade,in treating chronic heart failure in the future.
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