Toward a broader understanding of aldosterone in congestive heart failure.
Discovered some 50 years ago, aldosterone (ALDO) has come to be recognised as a mineralocorticoid hormone with well-known endocrine properties in epithelial cells that contribute to the pathophysiology of congestive heart failure. This includes Na+ resorption at the expense of K+ excretion in classic target tissues: kidneys, colon, sweat and salivary glands. Though less well known, Mg2+ excretion is likewise enhanced by ALDO, while adrenal ALDO secretion is regulated by extracellular Mg2+ ([Mg2+]o). An emerging body of information has and continues to identify other endocrine actions of ALDO receptor-ligand binding. They include: promoting an efflux of cytosolic free Mg2+, or [Mg2+]i, in exchange for Na+ in such non-epithelial cells as peripheral blood mononuclear cells; its influence on endothelial cell function; and its central actions that involve regulation of cerebrospinal fluid composition produced by epithelial cells of the choroid plexus, activity of the hypothalamic paraventricular nucleus involved in Na+ appetite, Na+ and H2O excretion and sympathetic nerve activity, and the regulation of TNF-alpha production from central and/or peripheral sources. Extra-adrenal steroidogenesis and auto/paracrine properties of ALDO generated de novo in the cardiovasculature are now under investigation and preliminary findings suggest they contribute to tissue repair. The past decade has witnessed a revival of interest in this steroid molecule. In years to come, an even broader understanding of ALDOs contribution to the pathophysiology of congestive heart failure will undoubtedly emerge.
Weber
Karl T
KT
Division of Cardiovascular Diseases, University of Tennessee, Memphis, Tennessee, 38163, USA. KTWeber@utmem.edu
Sun
Yao
Y
Wodi
Linus A
LA
Munir
Ahmad
A
Jahangir
Eiman
E
Ahokas
Robert A
RA
Gerling
Ivan C
IC
Postlethwaite
Arnold E
AE
Warrington
Kenneth J
KJ
D000450:Aldosterone / Q000502:physiology*; D000818:Animals; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D012084:Renin-Angiotensin System / Q000502:physiology*
D000450:Aldosterone