TY - JOUR
T1 - T-type Ca channel blockade as a determinant of kidney protection
AU - Hayashi, Koichi
AU - Homma, Koichiro
AU - Wakino, Shu
AU - Tokuyama, Hirobumi
AU - Sugano, Naoki
AU - Saruta, Takao
AU - Itoh, Hiroshi
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2010/9
Y1 - 2010/9
N2 - Voltage-dependent Ca channels are classified into several subtypes based on the isoform of their α1 subunits. Traditional Ca channels blockers (CCBs), including nifedipine and amlodip-ine, act predominantly on L-type Ca channels, whereas novel CCBs such as efonidipine, beni-dipine and azelnidipine inhibit both L-type and T-type Ca channels. Furthermore, cilnidipine blocks L-type and N-type Ca channels. These CCBs exert divergent actions on renal microves-sels. L-type CCBs preferentially dilate afferent arterioles, whereas both L-/T-type and L-/N-type CCBs potently dilate afferent and efferent arterioles. The distinct actions of CCBs on the renal microcirculation are reflected by changes in glomerular capillary pressure and subsequent renal injury: L-type CCBs favor an increase in glomerular capillary pressure, whereas L-/T-type and L-/N-type CCBs alleviate glomerular hypertension. The renal protective action of L-/T-type CCBs is also mediated by non-hemodynamic mechanisms, i.e., inhibition of the inflammatory process and inhibition of Rho kinase and aldosterone secretion. Finally, a growing body of evidence indicates that T-type CCBs offer more beneficial action on proteinuria and renal survival rate than L-type CCBs in patients with chronic kidney disease (CKD). Similarly, in CKD patients treated with renin-angiotensin blockers, add-on therapy with N-type CCBs is more potent in reducing proteinuria than that with L-type CCBs, although no difference is found in the subgroup with diabetic nephropathy. Thus, the strategy for hypertension treatment with CCBs has entered a new era: treatment selection depends not only on blood pressure control but also on the subtypes of CCBs.
AB - Voltage-dependent Ca channels are classified into several subtypes based on the isoform of their α1 subunits. Traditional Ca channels blockers (CCBs), including nifedipine and amlodip-ine, act predominantly on L-type Ca channels, whereas novel CCBs such as efonidipine, beni-dipine and azelnidipine inhibit both L-type and T-type Ca channels. Furthermore, cilnidipine blocks L-type and N-type Ca channels. These CCBs exert divergent actions on renal microves-sels. L-type CCBs preferentially dilate afferent arterioles, whereas both L-/T-type and L-/N-type CCBs potently dilate afferent and efferent arterioles. The distinct actions of CCBs on the renal microcirculation are reflected by changes in glomerular capillary pressure and subsequent renal injury: L-type CCBs favor an increase in glomerular capillary pressure, whereas L-/T-type and L-/N-type CCBs alleviate glomerular hypertension. The renal protective action of L-/T-type CCBs is also mediated by non-hemodynamic mechanisms, i.e., inhibition of the inflammatory process and inhibition of Rho kinase and aldosterone secretion. Finally, a growing body of evidence indicates that T-type CCBs offer more beneficial action on proteinuria and renal survival rate than L-type CCBs in patients with chronic kidney disease (CKD). Similarly, in CKD patients treated with renin-angiotensin blockers, add-on therapy with N-type CCBs is more potent in reducing proteinuria than that with L-type CCBs, although no difference is found in the subgroup with diabetic nephropathy. Thus, the strategy for hypertension treatment with CCBs has entered a new era: treatment selection depends not only on blood pressure control but also on the subtypes of CCBs.
KW - Chronic kidney disease
KW - Efonidipine
KW - Renal microcirculation
KW - T-type calcium channels
KW - Voltage-dependent Ca channels
UR - http://www.scopus.com/inward/record.url?scp=78249284594&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78249284594&partnerID=8YFLogxK
U2 - 10.2302/kjm.59.84
DO - 10.2302/kjm.59.84
M3 - Review article
C2 - 20881449
AN - SCOPUS:78249284594
SN - 0022-9717
VL - 59
SP - 84
EP - 95
JO - Keio Journal of Medicine
JF - Keio Journal of Medicine
IS - 3
ER -