Прямые кардиальные эффекты и механизмы кардиоваскулярного действия глифлозинов
- Авторы: Зверев Я.Ф.1, Рыкунова А.Я.2
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Учреждения:
- Алтайский государственный медицинский университет
- Барнаульский юридический институт
- Выпуск: Том 19, № 2 (2021)
- Страницы: 131-143
- Раздел: Научные обзоры
- URL: https://journals.rcsi.science/RCF/article/view/48605
- DOI: https://doi.org/10.17816/RCF192131-143
- ID: 48605
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Аннотация
Обзор литературы посвящен исследованию механизмов прямого кардиопротективного действия нового класса сахароснижающих препаратов глифлозинов, ингибирующих совместный транспорт натрия и глюкозы в проксимальных отделах почечных канальцев. Рассматриваются благоприятные изменения ионного транспорта в кардиомиоцитах (КМЦ) при применении этих препаратов. Установлено угнетение активности натрий-водородного обменника (NHE) с последующим снижением активности Na+/Ca2+-обмена на мембранах митохондрий КМЦ, что приводит к уменьшению концентрации Ca2+ в цитоплазме с одновременным ее увеличением в митохондриях. Это инициирует ряд внутриклеточных сигнальных каскадов, способствующих оптимизации митохондриального гомеостаза. Использование глифлозинов, по-видимому, обеспечивает баланс между слиянием и делением митохондрий, что обусловливает биоэнергетическую адаптацию клетки к состоянию внутриклеточного метаболизма, ослабляет развитие воспалительной реакции, фиброза и окислительного стресса в миокарде, активируемые в условиях сахарного диабета. Обсуждается точка зрения, согласно которой механизм противовоспалительного действия глифлозинов связан с угнетением активности инфламмасомы NLRP3, которая вносит вклад в прогрессирование миокардиальной дисфункции и последующей хронической сердечной недостаточности. Анализируются результаты клинических испытаний и данные экспериментальных исследований относительно благоприятного действия глифлозинов в условиях развития различных фенотипов сердечной недостаточности со сниженной и сохраненной фракцией выброса. Обосновывается предположение о перспективах более широкого применения этих сахароснижающих препаратов при сердечной недостаточности, не ограничивающейся лишь сахарным диабетом. Высказанные предположения требуют дальнейших экспериментальных и клинических исследований.
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Яков Федорович Зверев
Алтайский государственный медицинский университет
Автор, ответственный за переписку.
Email: zveryasha@mail.ru
ORCID iD: 0000-0002-8101-103X
SPIN-код: 4520-7720
Доктор медицинских наук, профессор кафедры фармакологии
Россия, 656038, Барнаул, пр. Ленина, 40Анна Яковлевна Рыкунова
Барнаульский юридический институт
Email: zveranna@mail.ru
ORCID iD: 0000-0002-5889-7071
SPIN-код: 4355-8205
кандидат медицинских наук
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