No description available.

A aldosterona participa da progressão das doenças renais em modelos experimentais e ensaios clínicos. Considerando que o modelo de hipertensão renovascular 2 rins-1 clipe (2R-1C) é caracterizado pela atividade elevada do sistema renina-angiotensina-aldosterona, o objetivo desse trabalho foi avaliar o papel da aldosterona na lesão renal presente nesse modelo através do bloqueio do receptor mineralocorticóide (RM) com espironolactona. Ratos Wistar foram submetidos ao procedimento cirúrgico para colocação de um clipe de prata na artéria renal esquerda e após 2 semanas do desenvolvimento da hipertensão renovascular 2R-1C, foram divididos em 3 grupos sendo que para o primeiro grupo nenhuma droga foi administrada (n=8), para o segundo grupo foi administrado por via oral 20 mg/Kg/dia de espironolactona (n=10) e para o terceiro, 7 mg/Kg/dia de amilorida (n=12). O peso e a pressão sistólica foram monitorados semanalmente. Coletas de urina (durante 24 h) e sangue foram realizadas em 3 períodos distintos: antes do procedimento cirúrgico; na 2° semana após a cirurgia (antes do início do tratamento) e na 6° semana após a cirurgia (após o término do tratamento). As amostras foram utilizadas para análise de creatinina, osmolalidade, sódio, potássio e albuminúria. Ao final do experimento, os rins foram perfundidos e pesados. Análise histológica para avaliar a extensão das alterações tubulointersticiais foi realizada. Além disso, marcadores de inflamação (ED-1 e p-JNK), de produção de matriz extracelular (fibronectina), de miofibroblastos (-actina de músculo liso) e de transdiferenciação tubular (vimentina) na região tubulointersticial cortical e de lesão nos podócitos (desmina) foram avaliados. O tratamento com espironolactona foi capaz de atenuar o aumento na excreção de albumina, o aumento na concentração plasmática de creatinina e a redução na depuração de creatinina. No rim clipado dos ratos 2R-1C, as lesões tubulointersticias e podocitárias, demonstradas pelos marcadores estudados, foram discretas e a terapia com espironolactona ou amilorida não foi capaz de minimizá-las. Por outro lado, no rim não clipado, a administração de espironolactona atenuou o aumento de matriz extracelular e a lesão nos podócitos. Os efeitos benéficos da espironolactona ocorreram independentes da redução na pressão sanguínea e podem ser em parte, dependentes do bloqueio do canal epitelial de sódio (ENaC). Tais efeitos trazem perspectiva para espironolactona como uma ferramenta terapêutica a ser explorada em pacientes com estenose de artéria renal. / Aldosterone is involved in the progression of renal disease in experimental models and clinical trials. Considering that the model of renovascular hypertension 2 kidney-1 clip (2K-1C) is characterized by a high activity of the renin-angiotensin-aldosterone system, the objective of this study was to assess the role of aldosterone in renal injury in this model by blocking the mineralocorticoid receptor (MR) with spironolactone. Male Wistar rats were submitted to surgery to place a silver clip on the left renal artery and after two weeks of the development of 2K-1C renovascular hypertension they were divided into three groups. The first group was administered no drug (n=8), in the second group spironolactone 20 mg/kg/day was given orally (n=10) and the third group received amiloride 7 mg/kg/day (n=12). Body weight and systolic blood pressure were monitored weekly. Samples of urine (collected for 24 h) and blood were performed in 3 distinct periods: before surgery; 2 weeks after surgery (before treatment) and 6 weeks after surgery (after treatment). The samples were used to analyze creatinine, osmolality, sodium, potassium and albuminuria. At the end of the experiment, the kidneys were perfused and weighed. Histological analysis to assess the extent of tubulointerstitial changes was performed. Additionally, markers of inflammation (ED-1 and p-JNK), production of extracellular matrix (fibronectin), myofibroblasts (-smooth muscle actin) and tubular transdifferentiation (vimentin) in the area of tubulointerstitial cortical and injury in podocytes (desmin) were evaluated. Treatment with spironolactone was able to attenuate the increase in albumin excretion, the increase in plasma concentration of creatinine and the reduction in creatinine clearance. In the clipped kidney, tubulointerstitial and podocytes injuries, demonstrated by markers studied, were discrete and therapy with spironolactone or amiloride was not able to minimize them. However, in the non-clipped kidney, administration of spironolactone attenuated the increase of extracellular matrix and podocyte injury. The beneficial effects of spironolactone occurred independent of the reduction blood pressure and can be partly dependent of epithelial sodium channel (ENaC) blockade. These effects bring perspective to espironolactone as a therapeutic tool to be explored in patients with renal artery stenosis.

A adolescência é um período crítico para o desenvolvimento dos indivíduos. Durante esta fase várias estruturas cerebrais responsáveis pelo controle das respostas estressoras atingem sua maturidade. Assim, estressores agudos ou crônicos podem repercutir negativamente e alterar a resposta de estresse bem como o comportamento na vida adulta. O eixo hipotálamo-hipófiseadrenal (HPA) integra o sistema do estresse, cujo controle inibitório está regulado pelos glicocorticoides, os quais agem em receptores dos tipos mineralocorticoide (MR) e glicocorticoide (GR). É desconhecido o papel destes receptores nos efeitos de longa duração induzidos pelo estresse na pré-puberdade em modelos animais. O objetivo deste trabalho foi verificar se o bloqueio dos receptores MR ou GR após o estresse na pré-puberdade previne suas alterações sobre o comportamento exploratório e o controle do eixo HPA, em ratas adultas. Desta forma, ratas pré-púberes, com 26 dias de idade, foram submetidas a uma ou sete sessões diárias de contenção e, em seguida, à administração dos antagonistas MR (Espironolactona) ou GR (RU- 486). Na fase adulta, aos 60 dias de idade, os animais foram avaliados no labirinto em cruz elevado e, no dia seguinte, submetidos novamente à contenção, concomitantemente com coleta seriada de sangue para avaliar a resposta do eixo HPA. Subsequentemente, realizou-se a perfusão do cérebro assim como a coleta das adrenais e timo. Efetuou-se a dosagem de corticosterona por radioimunoensaio e analisou-se a expressão e atividade dos neurônios CRH na região parvocelular medial do núcleo paraventricular do hipotálamo, por imuno-histoquímica. O estresse crônico na pré-puberdade causou redução no peso corporal, atraso na puberdade e diminuição da expressão de CRH e Fos em resposta ao estresse agudo na vida adulta. Não houve efeitos sobre o peso do timo e parâmetros comportamentais. Contudo, RU-486 promoveu aumento da corticosterona e adrenais. O estresse agudo ocasionou avanço da puberdade e associado com RU- 486 ou Espironolactona também diminuiu a atividade dos neurônios CRH em resposta ao mesmo estressor na vida adulta. Estes resultados demonstram que a administração de Espironolactona pode ser uma estratégia promissora para atenuar os efeitos centrais a longo prazo decorrentes do estresse agudo na pré-adolescência / Adolescence is a critical period to the individual\'s development. Several brain structures responsible for the control of stressful responses reach maturity during this phase. Thus, acute or chronic stressors can have a negative effect and alter the stress response as well as behavior in adulthood. The hypothalamus-pituitary-adrenal axis (HPA) is part of the stress system, whose inhibitory control is regulated by glucocorticoids through mineralocorticoid (MR) and glucocorticoid (GR) receptors. It is unknown the role of these receptors in the long-term effects induced by stress in the prepuberty in animals models. The aim of this study was determine whether MR or GR receptor blockade after stress in prepuberty prevents their changes on exploratory behavior and control of the HPA axis in adult female rats. Thus, prepuberty female rats, at 26 days old, were submitted to one or seven daily restraint sessions followed by administration of MR (Spironolactone) or GR (RU-486) antagonists. In adulthood, at 60 days old, the animals were evaluated in the elevated plus maze. In the next day, they were subject again to restraint concurrently with serial blood sampling to evaluate the HPA axis response. Subsequently, it was performed the brain perfusion as well as the collection of the adrenal glands and thymus. It was conducted the dosage of corticosterone by radioimmunoassay and analyzed the expression and activity of CRH neurons in the medial parvocellular subdivision of the paraventricular nucleus of the hypothalamus by immunohistochemistry. Chronic stress in prepuberty reduced the body weight, delayed the puberty and decreased the CRH and Fos expression in response to acute stress in adulthood. There was no effect on thymus weight and behavioral parameters. However, RU-486 increased the corticosterone secretion and adrenal glands weight. Acute stress caused advancement of puberty and associated with RU-486 or Spironolactone also reduced the activity of CRH neurons in response to the same stressor in adulthood. These results demonstrate that Spironolactone administration may be a promising strategy to attenuate the central long-term effects resulting from acute stress in prepuberty.

In Primary Aldosteronism (PAL) excessive amounts of aldosterone cause sodium and water retention and, in many individuals, this leads to moderate to severely high blood pressure. Although the chemistry and physiology are increasingly well understood, including the outcomes of treatment on physical health, there has been no systematic study of the psychological dimension of PAL. Anecdotally, patients exhibit symptoms such as angry outbursts, irritability, anxiety and defensiveness, and partners of these patients sometimes mention poor anger control and brittle or unpredictable moods. This thesis reports a systematic study of anger and anxiety among patients undergoing treatment for PAL. Eighty-three patients were recruited over an 11-month period to a prospective, pre-post design study to determine if treatment was associated with change in psychological state. Participants completed the State-Trait Anger Expression Inventory (STAXI-2), State-Trait Anxiety Inventory (STAI) and Psychosocial Adjustment to Illness Scale (PAIS) questionnaires. Adrenal Vein Sampling confirmed overproduction of aldosterone in one or both adrenal glands. Patients with Aldosterone Producing Adenoma (APA) were offered adrenalectomy. As per usual treatment protocols, patients with Bilateral Adrenal Hyperplasia (BAH) were prescribed spironolactone or amiloride depending predominantly on severity of blood pressure and potassium levels. Post-test questionnaires were completed after 6-8 months. Analysis was by mixed design (between-within subjects) ANOVA. Participant numbers in the adrenalectomy group fell far short of expectations. Fourteen past patients who had undergone unilateral adrenalectomy completed a retrospective semi-structured questionnaire. This qualitative data was analysed to identify themes similar to quantitative data. At baseline, 'non-completers' (ie those who did not complete the post-test; n=19), were significantly more angry than 'completers' (n=50) in State Anger (p< .01), Trait Anger (p< .05) and Anger Expression Index (p< .001). Trait Anxiety was also higher (p< .05), as was Psychological Distress (p< .05). Among those who participated at both interviews, there was small but statistically significant adverse treatment effect with higher scores for State Anger (p< .05), and Feeling Angry (p< .05). However for Trait Anger (p< .01), and 2 of its 3 sub-scales Angry Temperament (p< .05) and Angry Reaction (p< .01) there was a slight to moderate decrease in negative affect with treatment. Psychological Distress scores also improved (p< .05). Across all ANOVAs, there were no significant interaction effects, suggesting that any treatment effect was equivalent for the two drugs. Qualitatively collected data elucidated participants' changes in approach to life and relationships since adrenalectomy. Themes that emerged in the data included improved ability to cope with external stress, better control of emotions, more relaxed relationships and attitude to work, and a greater vitality and quality of life. Generally the comments were consistent with the drug treatments; there was noticeable benefit, including perceived better anger control and less anxiety. Positive psychological effects of treatment observed in the two drug groups were triangulated with data from a qualitative study. The combined evidence suggests that when excess circulating aldosterone is reduced (adrenalectomy), or blocked (spironolactone), or aldosterone's salt and water retaining effects are minimised (amiloride), then nervous irritability and its subsequent psycho-behavioural manifestations are reduced. The effect however is slight and the conclusions are weakened by an apparent attrition bias, and the absence of a control group. Implications for further research are discussed.

A adolescência é um período crítico para o desenvolvimento dos indivíduos. Durante esta fase várias estruturas cerebrais responsáveis pelo controle das respostas estressoras atingem sua maturidade. Assim, estressores agudos ou crônicos podem repercutir negativamente e alterar a resposta de estresse bem como o comportamento na vida adulta. O eixo hipotálamo-hipófiseadrenal (HPA) integra o sistema do estresse, cujo controle inibitório está regulado pelos glicocorticoides, os quais agem em receptores dos tipos mineralocorticoide (MR) e glicocorticoide (GR). É desconhecido o papel destes receptores nos efeitos de longa duração induzidos pelo estresse na pré-puberdade em modelos animais. O objetivo deste trabalho foi verificar se o bloqueio dos receptores MR ou GR após o estresse na pré-puberdade previne suas alterações sobre o comportamento exploratório e o controle do eixo HPA, em ratas adultas. Desta forma, ratas pré-púberes, com 26 dias de idade, foram submetidas a uma ou sete sessões diárias de contenção e, em seguida, à administração dos antagonistas MR (Espironolactona) ou GR (RU- 486). Na fase adulta, aos 60 dias de idade, os animais foram avaliados no labirinto em cruz elevado e, no dia seguinte, submetidos novamente à contenção, concomitantemente com coleta seriada de sangue para avaliar a resposta do eixo HPA. Subsequentemente, realizou-se a perfusão do cérebro assim como a coleta das adrenais e timo. Efetuou-se a dosagem de corticosterona por radioimunoensaio e analisou-se a expressão e atividade dos neurônios CRH na região parvocelular medial do núcleo paraventricular do hipotálamo, por imuno-histoquímica. O estresse crônico na pré-puberdade causou redução no peso corporal, atraso na puberdade e diminuição da expressão de CRH e Fos em resposta ao estresse agudo na vida adulta. Não houve efeitos sobre o peso do timo e parâmetros comportamentais. Contudo, RU-486 promoveu aumento da corticosterona e adrenais. O estresse agudo ocasionou avanço da puberdade e associado com RU- 486 ou Espironolactona também diminuiu a atividade dos neurônios CRH em resposta ao mesmo estressor na vida adulta. Estes resultados demonstram que a administração de Espironolactona pode ser uma estratégia promissora para atenuar os efeitos centrais a longo prazo decorrentes do estresse agudo na pré-adolescência / Adolescence is a critical period to the individual\'s development. Several brain structures responsible for the control of stressful responses reach maturity during this phase. Thus, acute or chronic stressors can have a negative effect and alter the stress response as well as behavior in adulthood. The hypothalamus-pituitary-adrenal axis (HPA) is part of the stress system, whose inhibitory control is regulated by glucocorticoids through mineralocorticoid (MR) and glucocorticoid (GR) receptors. It is unknown the role of these receptors in the long-term effects induced by stress in the prepuberty in animals models. The aim of this study was determine whether MR or GR receptor blockade after stress in prepuberty prevents their changes on exploratory behavior and control of the HPA axis in adult female rats. Thus, prepuberty female rats, at 26 days old, were submitted to one or seven daily restraint sessions followed by administration of MR (Spironolactone) or GR (RU-486) antagonists. In adulthood, at 60 days old, the animals were evaluated in the elevated plus maze. In the next day, they were subject again to restraint concurrently with serial blood sampling to evaluate the HPA axis response. Subsequently, it was performed the brain perfusion as well as the collection of the adrenal glands and thymus. It was conducted the dosage of corticosterone by radioimmunoassay and analyzed the expression and activity of CRH neurons in the medial parvocellular subdivision of the paraventricular nucleus of the hypothalamus by immunohistochemistry. Chronic stress in prepuberty reduced the body weight, delayed the puberty and decreased the CRH and Fos expression in response to acute stress in adulthood. There was no effect on thymus weight and behavioral parameters. However, RU-486 increased the corticosterone secretion and adrenal glands weight. Acute stress caused advancement of puberty and associated with RU-486 or Spironolactone also reduced the activity of CRH neurons in response to the same stressor in adulthood. These results demonstrate that Spironolactone administration may be a promising strategy to attenuate the central long-term effects resulting from acute stress in prepuberty.

A aldosterona participa da progressão das doenças renais em modelos experimentais e ensaios clínicos. Considerando que o modelo de hipertensão renovascular 2 rins-1 clipe (2R-1C) é caracterizado pela atividade elevada do sistema renina-angiotensina-aldosterona, o objetivo desse trabalho foi avaliar o papel da aldosterona na lesão renal presente nesse modelo através do bloqueio do receptor mineralocorticóide (RM) com espironolactona. Ratos Wistar foram submetidos ao procedimento cirúrgico para colocação de um clipe de prata na artéria renal esquerda e após 2 semanas do desenvolvimento da hipertensão renovascular 2R-1C, foram divididos em 3 grupos sendo que para o primeiro grupo nenhuma droga foi administrada (n=8), para o segundo grupo foi administrado por via oral 20 mg/Kg/dia de espironolactona (n=10) e para o terceiro, 7 mg/Kg/dia de amilorida (n=12). O peso e a pressão sistólica foram monitorados semanalmente. Coletas de urina (durante 24 h) e sangue foram realizadas em 3 períodos distintos: antes do procedimento cirúrgico; na 2° semana após a cirurgia (antes do início do tratamento) e na 6° semana após a cirurgia (após o término do tratamento). As amostras foram utilizadas para análise de creatinina, osmolalidade, sódio, potássio e albuminúria. Ao final do experimento, os rins foram perfundidos e pesados. Análise histológica para avaliar a extensão das alterações tubulointersticiais foi realizada. Além disso, marcadores de inflamação (ED-1 e p-JNK), de produção de matriz extracelular (fibronectina), de miofibroblastos (-actina de músculo liso) e de transdiferenciação tubular (vimentina) na região tubulointersticial cortical e de lesão nos podócitos (desmina) foram avaliados. O tratamento com espironolactona foi capaz de atenuar o aumento na excreção de albumina, o aumento na concentração plasmática de creatinina e a redução na depuração de creatinina. No rim clipado dos ratos 2R-1C, as lesões tubulointersticias e podocitárias, demonstradas pelos marcadores estudados, foram discretas e a terapia com espironolactona ou amilorida não foi capaz de minimizá-las. Por outro lado, no rim não clipado, a administração de espironolactona atenuou o aumento de matriz extracelular e a lesão nos podócitos. Os efeitos benéficos da espironolactona ocorreram independentes da redução na pressão sanguínea e podem ser em parte, dependentes do bloqueio do canal epitelial de sódio (ENaC). Tais efeitos trazem perspectiva para espironolactona como uma ferramenta terapêutica a ser explorada em pacientes com estenose de artéria renal. / Aldosterone is involved in the progression of renal disease in experimental models and clinical trials. Considering that the model of renovascular hypertension 2 kidney-1 clip (2K-1C) is characterized by a high activity of the renin-angiotensin-aldosterone system, the objective of this study was to assess the role of aldosterone in renal injury in this model by blocking the mineralocorticoid receptor (MR) with spironolactone. Male Wistar rats were submitted to surgery to place a silver clip on the left renal artery and after two weeks of the development of 2K-1C renovascular hypertension they were divided into three groups. The first group was administered no drug (n=8), in the second group spironolactone 20 mg/kg/day was given orally (n=10) and the third group received amiloride 7 mg/kg/day (n=12). Body weight and systolic blood pressure were monitored weekly. Samples of urine (collected for 24 h) and blood were performed in 3 distinct periods: before surgery; 2 weeks after surgery (before treatment) and 6 weeks after surgery (after treatment). The samples were used to analyze creatinine, osmolality, sodium, potassium and albuminuria. At the end of the experiment, the kidneys were perfused and weighed. Histological analysis to assess the extent of tubulointerstitial changes was performed. Additionally, markers of inflammation (ED-1 and p-JNK), production of extracellular matrix (fibronectin), myofibroblasts (-smooth muscle actin) and tubular transdifferentiation (vimentin) in the area of tubulointerstitial cortical and injury in podocytes (desmin) were evaluated. Treatment with spironolactone was able to attenuate the increase in albumin excretion, the increase in plasma concentration of creatinine and the reduction in creatinine clearance. In the clipped kidney, tubulointerstitial and podocytes injuries, demonstrated by markers studied, were discrete and therapy with spironolactone or amiloride was not able to minimize them. However, in the non-clipped kidney, administration of spironolactone attenuated the increase of extracellular matrix and podocyte injury. The beneficial effects of spironolactone occurred independent of the reduction blood pressure and can be partly dependent of epithelial sodium channel (ENaC) blockade. These effects bring perspective to espironolactone as a therapeutic tool to be explored in patients with renal artery stenosis.

The pathophysiology of heart failure with preserved ejection fraction (HFpEF) is poorly understood and therapeutic strategies are lacking. This study aimed to identify plasma proteins with pathophysiological relevance in HFpEF and with respect to spironolactone-induced effects. We assessed 92 biomarkers in plasma samples from 386 HFpEF patients—belonging to the Aldo-DHF trial—before (baseline, BL) and after one-year treatment (follow up, FU) with spironolactone (verum) or a placebo. At BL, various biomarkers showed significant associations with the two Aldo-DHF primary end point parameters: 33 with E/e’ and 20 with peak VO2. Ten proteins including adrenomedullin, FGF23 and inflammatory peptides (e.g., TNFRSF11A, TRAILR2) were significantly associated with both parameters, suggesting a role in the clinical HFpEF presentation. For 13 proteins, expression changes from BL to FU were significantly different between verum and placebo. Among them were renin, growth hormone, adrenomedullin and inflammatory proteins (e.g., TNFRSF11A, IL18 and IL4RA), indicating distinct spironolactone-mediated effects. BL levels of five proteins, e.g., inflammatory markers such as CCL17, IL4RA and IL1ra, showed significantly different effects on the instantaneous risk for hospitalization between verum and placebo. This study identified plasma proteins with different implications in HFpEF and following spironolactone treatment. Future studies need to define their precise mechanistic involvement.

No description available.

INTRODUCTION : L’insuffisance cardiaque congestive (ICC) induit remodelage pulmonaire et dysfonction ventriculaire droite (VD) qui contribuent de façon importante à la morbidité/mortalité. Malgré l’efficacité prouvée, l’antagonisme des récepteurs minéralocorticoïdes est sous-utilisé en ICC et ses mécanismes d’actions demeurent incompris. Nous avons évalué si l’Aldostérone contribue au remodelage pulmonaire et à la dysfonction VD en stimulant la prolifération des myofibroblastes (MYFs) pulmonaires. MÉTHODE ET RÉSULTATS : L’étude a été réalisée chez des rats avec infarctus du myocarde (IM) de taille modérée à grande permettant le développement de l’ICC. Deux semaines après l’IM, les rats ont été traités avec 100mg/kg/jour d’Aldactone ou non, pendant trois semaines et comparé à un groupe témoin (N=21;24;8). Comparativement au groupe témoin, les rats IM ont développé une ICC caractérisée par une réduction de la fraction de raccourcissement du VG (53±1%vs.16±2%, moyenne±ESM, P<0.0001), une hypertension pulmonaire (PSVD:27±1vs.40±3mmHg, P<0.01) et une hypertrophie VD (VD/(VG+Septum):24±1%vs.38±3%, P<0.05). L’Aldactone n’a eu aucun effet sur ces paramètres. Les rats IM ont développé un syndrome pulmonaire caractérisé par un abaissement de la courbe respiratoire pression-volume, un remodelage structurel pulmonaire avec doublement du poids poumon sec (P<0.01) et de la fibrose pulmonaire avec augmentation du taux de collagène dans les poumons (P<0.05). L’Aldactone n’a pas restauré la fonction pulmonaire. Enfin, les MYFs pulmonaires isolés n’ont pas proliféré avec l’exposition de 48h aux deux traitements d’Aldostérone (10-7M, 10-6M). CONCLUSION : L’Aldostérone ne contribue pas au remodelage pulmonaire et à la dysfonction VD associés à l’ICC. D’autres mécanismes d’actions sont responsables des effets bénéfiques de l’Aldactone. / BACKGROUND: Congestive heart failure (CHF) can induce pulmonary remodeling and RV dysfunction, which importantly contribute to morbidity and mortality. Despite proven efficacy, antagonism of mineralocorticoid receptors is underused in CHF and the mechanisms of its benefits still debated. We hypothesized that Aldosterone contributes to pulmonary remodeling and RV dysfunction by stimulating lung myofibroblasts (MYFs) proliferation. METHODS AND RESULTS: We studied rats with moderate to large myocardial infarcts (MI) to allow CHF development. Two weeks after MI, rats were treated with Aldactone 100mg/kg/day (N=21) or untreated (N=24) for three weeks and compared to a sham group (N=8). Five weeks after MI, infarct size was similar in the two MI groups, both by ultrasound and pathologic measures. Compared to sham, the MI-untreated group developed CHF with reduced LV fractional shortening (53±1%vs.16±2%; mean±SEM, P<0.0001), pulmonary hypertension (RVSP:27±1vs.40±3mmHg, P<0.01) and RV hypertrophy (RV/(LV+septum):24±1%vs.38±3%, P<0.05). Aldactone treatment had no effect on these parameters and did not improve LV or RV performance. CHF induced a restrictive respiratory syndrome characterized by a downward shift of the respiratory pressure-volume loop, important lung remodeling with nearly doubling of dry lung weight (P<0.01) and evidence of lung fibrosis demonstrated by histological lung collagen fractional area (P<0.05). The Aldactone therapy could not restore pulmonary function. Finally, isolated lung MYFs did not proliferate after 48hr exposure to aldosterone (10-7M and 10-6M). CONCLUSION: Aldosterone does not contribute to pulmonary remodeling and RV dysfunction associated with CHF. Other mechanisms of action must be responsible for the beneficial effects of Aldactone in CHF.

INTRODUCTION : L’insuffisance cardiaque congestive (ICC) induit remodelage pulmonaire et dysfonction ventriculaire droite (VD) qui contribuent de façon importante à la morbidité/mortalité. Malgré l’efficacité prouvée, l’antagonisme des récepteurs minéralocorticoïdes est sous-utilisé en ICC et ses mécanismes d’actions demeurent incompris. Nous avons évalué si l’Aldostérone contribue au remodelage pulmonaire et à la dysfonction VD en stimulant la prolifération des myofibroblastes (MYFs) pulmonaires. MÉTHODE ET RÉSULTATS : L’étude a été réalisée chez des rats avec infarctus du myocarde (IM) de taille modérée à grande permettant le développement de l’ICC. Deux semaines après l’IM, les rats ont été traités avec 100mg/kg/jour d’Aldactone ou non, pendant trois semaines et comparé à un groupe témoin (N=21;24;8). Comparativement au groupe témoin, les rats IM ont développé une ICC caractérisée par une réduction de la fraction de raccourcissement du VG (53±1%vs.16±2%, moyenne±ESM, P<0.0001), une hypertension pulmonaire (PSVD:27±1vs.40±3mmHg, P<0.01) et une hypertrophie VD (VD/(VG+Septum):24±1%vs.38±3%, P<0.05). L’Aldactone n’a eu aucun effet sur ces paramètres. Les rats IM ont développé un syndrome pulmonaire caractérisé par un abaissement de la courbe respiratoire pression-volume, un remodelage structurel pulmonaire avec doublement du poids poumon sec (P<0.01) et de la fibrose pulmonaire avec augmentation du taux de collagène dans les poumons (P<0.05). L’Aldactone n’a pas restauré la fonction pulmonaire. Enfin, les MYFs pulmonaires isolés n’ont pas proliféré avec l’exposition de 48h aux deux traitements d’Aldostérone (10-7M, 10-6M). CONCLUSION : L’Aldostérone ne contribue pas au remodelage pulmonaire et à la dysfonction VD associés à l’ICC. D’autres mécanismes d’actions sont responsables des effets bénéfiques de l’Aldactone. / BACKGROUND: Congestive heart failure (CHF) can induce pulmonary remodeling and RV dysfunction, which importantly contribute to morbidity and mortality. Despite proven efficacy, antagonism of mineralocorticoid receptors is underused in CHF and the mechanisms of its benefits still debated. We hypothesized that Aldosterone contributes to pulmonary remodeling and RV dysfunction by stimulating lung myofibroblasts (MYFs) proliferation. METHODS AND RESULTS: We studied rats with moderate to large myocardial infarcts (MI) to allow CHF development. Two weeks after MI, rats were treated with Aldactone 100mg/kg/day (N=21) or untreated (N=24) for three weeks and compared to a sham group (N=8). Five weeks after MI, infarct size was similar in the two MI groups, both by ultrasound and pathologic measures. Compared to sham, the MI-untreated group developed CHF with reduced LV fractional shortening (53±1%vs.16±2%; mean±SEM, P<0.0001), pulmonary hypertension (RVSP:27±1vs.40±3mmHg, P<0.01) and RV hypertrophy (RV/(LV+septum):24±1%vs.38±3%, P<0.05). Aldactone treatment had no effect on these parameters and did not improve LV or RV performance. CHF induced a restrictive respiratory syndrome characterized by a downward shift of the respiratory pressure-volume loop, important lung remodeling with nearly doubling of dry lung weight (P<0.01) and evidence of lung fibrosis demonstrated by histological lung collagen fractional area (P<0.05). The Aldactone therapy could not restore pulmonary function. Finally, isolated lung MYFs did not proliferate after 48hr exposure to aldosterone (10-7M and 10-6M). CONCLUSION: Aldosterone does not contribute to pulmonary remodeling and RV dysfunction associated with CHF. Other mechanisms of action must be responsible for the beneficial effects of Aldactone in CHF.