Article(id=1239201873316598180, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1239201870791627164, articleNumber=null, orderNo=null, doi=10.14109/j.cnki.xyylc.2024.03.02, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1658246400000, receivedDateStr=2022-07-20, revisedDate=null, revisedDateStr=null, acceptedDate=1680710400000, acceptedDateStr=2023-04-06, onlineDate=1773378349856, onlineDateStr=2026-03-13, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773378349856, onlineIssueDateStr=2026-03-13, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773378349856, creator=13701087609, updateTime=1773378349856, updator=13701087609, issue=Issue{id=1239201870791627164, tenantId=1146029695717560320, journalId=1205117082300743687, year='2024', volume='43', issue='3', pageStart='161', pageEnd='240', issueExtLink='null', onlineDate='null', pubDate='1711296000000', pubDateStr='2024-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773378349254, creator='13701087609', updateTime=1773378470498, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1239202379392938830, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1239201870791627164, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1239202379397133135, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1239201870791627164, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=170, endPage=176, ext={EN=ArticleExt(id=1239201873647948201, articleId=1239201873316598180, tenantId=1146029695717560320, journalId=1205117082300743687, language=EN, title=Research progress in pharmacological action and clinical application of carvedilol, columnId=1207314219599499390, journalTitle=Chinese Journal of New Drugs and Clinical Remedies, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Carvedilol, a β-blocker with the function of blocking α1 and β adrenoceptors, has been widely used in existing clinical practice for cardio vascular diseases, such as hypertension, chronic heart failure and arrhythmia. In recent years, some clinical researches showed that carvedilol might have some potentially novelty prospect on prevention of atherosclerosis, protection of cardiac function of patients with different complications, improvement of diabetic patients’ ability to regulate blood sugar, and treatment of breast cancer and Alzheimer’s disease. Moreover, with the further study of G protein coupled receptor (GPCR), the special mechanism of β-arrestin-biased GPCR signal transduction had been found in carvedilol, Which could contribute to its highly selective action on target cells and could reduce the incidence of adverse drug reactions.

, authors=null, authorsList=Zi-hao ZHOU, Fan YANG, Ya-dong TANG, Ru-yan LI, Si-qi LUO, Hang YU, Rui-nan YANG, Ya-jing LIU, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1239201874113515965, articleId=1239201873316598180, tenantId=1146029695717560320, journalId=1205117082300743687, language=CN, title=卡维地洛药理作用与临床应用研究进展, columnId=1207314219767271558, journalTitle=中国新药与临床杂志, columnName=综述, runingTitle=null, highlight=null, articleAbstract=

卡维地洛作为肾上腺素β受体阻滞药,对α1和β受体均有阻断作用,在临床上已广泛应用于高血压、心力衰竭、心律失常等心血管疾病。近年来,在预防动脉粥样硬化、保护不同并发症患者的心脏功能、改善糖尿病患者血糖调节能力、防治乳腺癌和抗阿尔茨海默病等方面进行了多项卡维地洛的临床研究。此外,随着对G蛋白偶联受体(GPCR)的深入研究,发现卡维地洛存在独特的偏向β-抑制蛋白的GPCR信号传导,高选择性作用于靶细胞,可减少药物不良反应的发生。

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周子豪,男,本科在读,主要从事卡维地洛衍生物设计、合成与抗阿尔茨海默病药物的研究,E-mail:

刘亚婧,女,教授,博士,主要从事抗肿瘤、抗阿尔茨海默病药物设计与合成的研究,Phn: 86-24-4352-0217,E-mail:

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刘亚婧
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周子豪,男,本科在读,主要从事卡维地洛衍生物设计、合成与抗阿尔茨海默病药物的研究,E-mail:

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刘亚婧,女,教授,博士,主要从事抗肿瘤、抗阿尔茨海默病药物设计与合成的研究,Phn: 86-24-4352-0217,E-mail:

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刘亚婧,女,教授,博士,主要从事抗肿瘤、抗阿尔茨海默病药物设计与合成的研究,Phn: 86-24-4352-0217,E-mail:

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卡维地洛药理作用与临床应用研究进展
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周子豪 , 杨帆 , 汤雅东 , 李茹艳 , 罗思琦 , 于航 , 杨瑞楠 , 刘亚婧
中国新药与临床杂志 | 综述 2024,43(3): 170-176
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中国新药与临床杂志 |综述 2024 , 43 (3) : 170 -176
卡维地洛药理作用与临床应用研究进展
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刘亚婧,女,教授,博士,主要从事抗肿瘤、抗阿尔茨海默病药物设计与合成的研究,Phn: 86-24-4352-0217,E-mail:

"}, bioImg=null, bioContent=

刘亚婧,女,教授,博士,主要从事抗肿瘤、抗阿尔茨海默病药物设计与合成的研究,Phn: 86-24-4352-0217,E-mail:

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周子豪 , 杨帆, 汤雅东, 李茹艳, 罗思琦, 于航, 杨瑞楠, 刘亚婧
作者信息
  • 沈阳药科大学 基于靶点的药物设计与研究教育部重点实验室,辽宁 沈阳 110016
通讯作者:
刘亚婧
Research progress in pharmacological action and clinical application of carvedilol
Zi-hao ZHOU , Fan YANG, Ya-dong TANG, Ru-yan LI, Si-qi LUO, Hang YU, Rui-nan YANG, Ya-jing LIU
Affiliations
  • Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang LIAONING 110016, China
出版时间: 2024-03-25 doi: 10.14109/j.cnki.xyylc.2024.03.02
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卡维地洛作为肾上腺素β受体阻滞药,对α1和β受体均有阻断作用,在临床上已广泛应用于高血压、心力衰竭、心律失常等心血管疾病。近年来,在预防动脉粥样硬化、保护不同并发症患者的心脏功能、改善糖尿病患者血糖调节能力、防治乳腺癌和抗阿尔茨海默病等方面进行了多项卡维地洛的临床研究。此外,随着对G蛋白偶联受体(GPCR)的深入研究,发现卡维地洛存在独特的偏向β-抑制蛋白的GPCR信号传导,高选择性作用于靶细胞,可减少药物不良反应的发生。

卡维地洛  /  药理作用  /  受体,G蛋白偶联  /  临床应用

Carvedilol, a β-blocker with the function of blocking α1 and β adrenoceptors, has been widely used in existing clinical practice for cardio vascular diseases, such as hypertension, chronic heart failure and arrhythmia. In recent years, some clinical researches showed that carvedilol might have some potentially novelty prospect on prevention of atherosclerosis, protection of cardiac function of patients with different complications, improvement of diabetic patients’ ability to regulate blood sugar, and treatment of breast cancer and Alzheimer’s disease. Moreover, with the further study of G protein coupled receptor (GPCR), the special mechanism of β-arrestin-biased GPCR signal transduction had been found in carvedilol, Which could contribute to its highly selective action on target cells and could reduce the incidence of adverse drug reactions.

carvedilol  /  pharmacological actions  /  receptors, G-protein-coupled  /  clinical study
周子豪, 杨帆, 汤雅东, 李茹艳, 罗思琦, 于航, 杨瑞楠, 刘亚婧. 卡维地洛药理作用与临床应用研究进展. 中国新药与临床杂志, 2024 , 43 (3) : 170 -176 . DOI: 10.14109/j.cnki.xyylc.2024.03.02
Zi-hao ZHOU, Fan YANG, Ya-dong TANG, Ru-yan LI, Si-qi LUO, Hang YU, Rui-nan YANG, Ya-jing LIU. Research progress in pharmacological action and clinical application of carvedilol[J]. Chinese Journal of New Drugs and Clinical Remedies, 2024 , 43 (3) : 170 -176 . DOI: 10.14109/j.cnki.xyylc.2024.03.02
卡维地洛(carvedilol)是由罗氏(Roche)公司开发的第三代肾上腺素β受体阻滞药,临床使用外消旋体,主要用于原发性高血压及充血性心力衰竭的治疗。随着对卡维地洛研究的不断深入,发现其具有抗氧化、心脏血管保护、抑制肿瘤细胞增殖、钙离子通路阻滞等方面的作用[1],因此,近年来在预防动脉粥样硬化(atherosclerosis, AS)、保护心肌、抗肿瘤、防治糖尿病、抗阿尔茨海默病(Alzheimer’s disease, AD)等方向开展了多项临床试验。本文重点介绍卡维地洛药理与临床应用研究新进展。
AS是由脂质代谢异常所引起的,是冠心病、外周血管疾病等的主要原因。已有的研究表明,卡维地洛可以通过多种途径预防或治疗AS。卡维地洛的咔唑环部分和侧链羟基(-OH)可以与金属离子螯合,特别是铁离子(Fe3+)和铜离子(Cu2+),螯合后可以显著减弱金属离子的氧化能力[1]。卡维地洛是亲脂性化合物,在体外实验中,长期给予高浓度的卡维地洛会在低密度脂蛋白(LDL)中积累,直接破坏并清除LDL和因过氧化物产生的自由基,减少主动脉中泡沫细胞数量和脂质过氧化物中间体的形成,进而阻止因过氧化物中间体造成的相关蛋白构象的转变,并有效减少AS斑块的沉积[2]。卡维地洛体内代谢产物SB211475和SB209995能够抑制巨噬细胞氧化LDL,且抗氧化性远强于卡维地洛,可有效抑制氧自由基介导的心肌细胞毒性[2]。此外,卡维地洛还能阻止白细胞黏附在血管平滑肌上,减少黄嘌呤氧化酶和中性粒细胞对血管内皮的损伤(EC50 = 0.19 μmol·L-1),保护血管的完整性[3]
氯沙坦能够保护血管内皮,预防AS的形成。NCT00496834试验[4]纳入201例原发性高血压患者,采用双盲法分为卡维地洛(12.5 mg·d-1)组和氯沙坦(50 mg·d-1)组,治疗24周。测量脉搏传导速度(PWV)作为评价AS程度的指标,对PWV变化的平均差进行非劣效检验。结果发现卡维地洛治疗AS的疗效不劣于氯沙坦,可能成为防治AS的潜在用药。
卡维地洛作为治疗充血性心力衰竭和心绞痛的经典临床用药,其药理作用已经被多次报道并得以确证。近期,多项临床试验发现卡维地洛对MIRI具有潜在的治疗效果,可单独用药或联合用药对ST段抬高心肌梗死[5]、急性心肌梗死合并左心室功能不全[6]等不同适应证下的心肌起到良好的保护作用。
MIRI由多种原因引发,包括细胞内钙离子通道过度开放导致的钙超载、细胞内能量的异常代谢和自由基损伤等。卡维地洛对β受体的阻断作用可使肾上腺素释放减少,改善心肌的结构与功能。卡维地洛对不同部位肾上腺素α受体有不同程度的阻断作用,对血管上α受体的阻断作用会降低血管外周阻力,增加心肌的供血量;卡维地洛虽然也对心肌上α受体有抑制作用,但因血管外周阻力降低促使后负荷减少,因此对心脏指数影响不大[7]。卡维地洛的抗氧化性可保护心肌微血管内皮的完整性,抑制线粒体膜通透性转运孔上蛋白巯基的氧化并降低黄嘌呤氧化酶系统的活性,进而保护线粒体的结构与功能,同时降低活性氧(ROS)的产生。其次,Ca2+作为细胞内重要的信使,对线粒体酶的活性具有调节作用,当细胞内Ca2+浓度过高,会降低线粒体酶活性,从而产生过量的自由基和ROS[8]。卡维地洛对钙通道的抑制作用会改善Ca2+超载现象,对受损心肌细胞产生保护作用[9]。目前已发现AMP活化蛋白激酶(AMPK)作为重要的能量调节因子与糖代谢和脂代谢密切相关,在激活状态下可以参与体内氧化应激、细胞凋亡和炎症等多种生理过程,这些生理过程与MIRI的致病机制密切相关[10]。在正常条件下,卡维地洛对AMPK的表达不会产生影响;而在缺氧条件下,卡维地洛明显提高了AMPK的表达,升高心肌细胞的钙信号水平,发挥保护心肌细胞的作用[11]。动物实验结果表明,卡维地洛通过活化AMPK信号通路,可显著减少MIRI后的梗死面积[9]。除此之外,卡维地洛能上调A型钠尿肽(ANP)受体和B型钠尿肽(BNP)受体mRNA的表达并下调C型钠尿肽(CNP)受体mRNA的表达[12],在一定程度上提高了心肌细胞的收缩能力。
肝硬化患者常患有肝硬化性心肌病(CCM),可出现左心室增厚肥大,造成左心室前负荷增加,伴随左心房充盈量增加;肝硬化还可引起机体高动力循环使扩血管代谢产物激增,全身血管舒张,血管外周阻力减少,回心血量减少,进而降低左心室的后负电荷[13];此外,CCM患者的交感神经和肾素-血管紧张素-醛固酮系统过度激活,心脏为了维持对全身组织的血液供给,长期处于代偿状态,造成心室舒张末期过度充盈,心室容量负荷增加,最终引起心源性水肿、心肌肥大并纤维化和左心室功能不全(LVDD)等症状[14]。临床治疗LVDD首选方案是减少前负荷、改善交感神经过度兴奋并降低心率,非选择性β受体阻滞药常用于降低心率的治疗[15]。卡维地洛作为一种非选择性β受体阻滞药,还额外具有阻断α1受体内在活性的作用,在临床试验中表现出良好的预防肝硬化出血作用[16],可提高肝硬化患者的生存率[17],但由于肝硬化患者代谢功能障碍,单用卡维地洛降低心率治疗效果的最低给药量仍存在超过患者最大耐受剂量的风险。伊伐布雷定为窦房结If通道阻滞剂,用于心律失常和心力衰竭的治疗[18]。一项临床试验讨论了卡维地洛联合伊伐布雷定对肝硬化患者LVDD的疗效。受试者先给予卡维地洛,初始剂量为3.125 mg,每日2次,每周递增给药剂量直至达到患者的最大耐受剂量,筛选出心率仍未降低的患者继续联合使用伊伐布雷定,起始剂量为2.5 mg,每日2次,每周增加2.5 mg直到最大剂量7.5 mg,每日2次,给药维持12个月,监测患者心率、血压等参数。结果表明,联合用药治疗患者的E/e'指标下降较单独使用卡维地洛患者提高10.2%,左心室功能改善且生存率显著提高[19]。因此,卡维地洛联合伊伐布雷定可能成为临床靶向LVDD的潜在治疗方案。
蒽环类药物(ANT)多柔比星等是目前临床常用的肿瘤化疗药物,但其可对心肌造成不可逆的毒性损伤,尤其表现为心力衰竭,在乳腺癌患者中多发,因此很大程度上限制了ANT类化疗药的临床应用[20]。基于对目前一、二线预防和治疗心脏毒性方案的分析,可采用β受体阻滞药防治ANT引起的心力衰竭[21]。在卡维地洛预防ANT诱发心脏毒性的非随机临床研究中,卡维地洛改善患者左室射血分数并对心力衰竭有较好的治疗效果,因此提出卡维地洛可能作为一线预防ANT并发症的候选药物[22,23]。在探究β受体阻滞药用于预防化疗相关心肌毒性的临床试验中,采用随机双盲法,将200例接受化疗的人表皮生长因子受体2(HER2)阴性乳腺癌成年患者随机分为卡维地洛组和安慰剂组,口服给药,初始剂量为3.125 mg,每日2次,逐渐递增直至最大耐受剂量25 mg,给药6个月。试验结果表明,使用卡维地洛后,患者心肌肌钙蛋白升高显著减弱,提示卡维地洛对ANT类化疗药物产生的心肌损伤可能具有改善作用[24],但由于缺乏较长时间的观察和随访,该结论有待进一步临床试验和数据的支撑。
2型糖尿病的致病假说之一为氧化应激与应激信号通路的激活,即当细胞暴露在高糖和某些代谢物如游离脂肪酸(FFA)下,导致ROS和活性氮(RNS)增多,诱发氧化应激效应[25]。内源性抗氧化系统缺少适当代偿调节,导致应激信号通路激活,造成细胞损伤,最终导致糖尿病及其并发症的发生。此外,激活的应激通路还会抑制胰岛素的分泌。因此,利用抗氧化剂抵抗氧化应激并抑制应激通路的开放成为糖尿病治疗的重要策略[26]。在对比比索洛尔和卡维地洛治疗2型糖尿病的临床研究中,发现卡维地洛改善收缩性心力衰竭的疗效与比索洛尔相似,还会显著提高2型糖尿病患者对血糖的控制能力。
糖尿病神经病变(DN)是糖尿病(1型和2型)并发症中的常见症状,研究证实DN是糖尿病患者住院和非创伤性截肢的主要原因[27]。引起糖尿病患者DN的原因有ROS的过度产生、谷氨酸水平的降低、细胞内Ca2+浓度的增加以及促凋亡因子的释放。而卡维地洛兼具抗氧化和钙通道阻滞作用,即可降低氧化酶的活性,又可直接与ROS结合,起到对神经纤维的保护作用[28,29]。目前,已证实卡维地洛能够抑制神经元中铂诱导的氧化应激,同时还能提高链脲佐菌素(STZ)诱导糖尿病合并神经再灌注损伤模型的神经元的传导速率[30,31]。背根神经节(DRG)常作为评价糖尿病对神经元作用的体外模型。在体外实验中,DRG在高糖环境下活性降低,给予卡维地洛后DRG的活性显著提高,神经元结构和形态显著改善[32]。STZ诱导的糖尿病会降低机体内谷胱甘肽(GSH)的含量并激活超氧化物歧化酶(SOD)和神经生长因子(NGF),在体内实验中,高剂量的卡维地洛明显降低STZ诱导的氧化应激标志物丙二醛(MDA)的产生,恢复GSH的含量,有效降低SOD的活性及NGF水平,起到神经保护作用[33]。此外,卡维地洛还对缺血性脑组织的神经元具有保护作用,这可能与其抑制促凋亡因子的释放、抑制肿瘤坏死因子(TNF)-α与白细胞介素(IL)-1的表达有关[28,33]
1型糖尿病的主要特点是胰岛β细胞功能受损,导致胰岛素分泌量降低。由T细胞和巨噬细胞释放的促炎细胞因子环氧化酶(COX)-2和趋化因子诱导型一氧化氮合酶(iNOS)会触发胰岛细胞的炎症反应,最终导致胰岛细胞的功能障碍、损伤和凋亡[34]。卡维地洛能够抑制COX-2和iNOS的表达,从而减少NO的过度释放[35]。另一项研究表明,转录调节因子核因子(NF)-κB的激活与炎症密切相关,抑制NF-κB活性被认为是保护胰岛β细胞和预防糖尿病的有效手段[36]。多次低剂量给予STZ可增加iNOS和COX-2的表达以及NO的释放,而卡维地洛治疗(15 mg·kg-1·d-1和20 mg·kg-1·d-1)可显著抑制STZ诱导的小鼠胰腺中iNOS、COX-2和NF-κB的表达和NO的产生,对胰岛β细胞起到了保护作用[36]
研究表明,交感神经和β受体信号通路与肿瘤的扩散和转移密切相关。交感神经被激活释放儿茶酚胺,与肿瘤微环境中的β受体结合,驱动信号级联放大,调节肿瘤的转移和侵袭、血管重构和免疫抑制等相关基因的表达[37]。β受体信号激活腺苷酸环化酶,导致环磷酸腺苷(cAMP)的积累并调节相关基因的转录[38]。研究证实卡维地洛在肿瘤细胞中可以降低cAMP,通过抑制β信号传导和其他表皮生长因子受体的反转录激活,进而刺激细胞外蛋白激酶(ERK)磷酸化[39]。实验表明,在MDA-MB-231肿瘤细胞中,卡维地洛对基础的cAMP没有影响,但可降低异丙肾上腺素诱导的cAMP的积累。基质金属蛋白酶(MMP)-2在肿瘤细胞的扩散中促进基质的降解,卡维地洛可以降低异丙肾上腺素诱导的MMP-2表达[39],说明卡维地洛可阻断肿瘤的扩散和转移。
除此之外,卡维地洛可拮抗由异丙肾上腺素造成的心率增加,有效降低应激诱导的交感神经系统生理激活,降低小鼠的应激逃避行为。在发生应激的癌症小鼠和正常环境下癌症小鼠中给予卡维地洛干预,观察到应激小鼠原发性肿瘤的生长和扩散明显降低,而在正常环境下的癌症小鼠无明显改善[39,40]
GILLIS等[39]通过检索挪威处方数据库和癌症注册数据库,对使用卡维地洛与乳腺癌症患者死亡率的相关性进行研究。对收纳样本制定严格的筛选细则,并采用单变量分析,分析结果表明,卡维地洛使用者和非卡维地洛使用者对应的5年累计乳腺癌死亡率分别为3.1%和5.7%,存在显著差异。因此,卡维地洛可能作为治疗乳腺癌的潜在用药。目前,卡维地洛治疗乳腺癌的Ⅰ期和Ⅱ期临床试验已取得了良好的结果并达到预期,相关Ⅲ期临床试验(NCT03418961等)正在进行中。
AD是一种典型的复杂多因素、遗传异质性疾病,其发病机制尚不明确,海马区CA1锥体区神经元的过度活跃是家族性和散发性AD患者的早期症状,但其潜在机制尚不明确[41,42]
研究表明,R-卡维地洛可缩短Ryanodine受体2(RyR2)的开放时间,预防和逆转不同AD小鼠模型的神经元过度活跃、记忆损伤和神经元细胞死亡,而不会影响Aβ的积累[43]
在临床试验(NCT001354444)中,采用双盲法将AD患者分为卡维地洛(25 mg·d-1)组和安慰剂组,给药6个月,通过测试AD患者脑脊液中Aβ水平、情景记忆能力、霍普金斯言语学习测试(HVLT)及立即和延迟回忆评分,观察卡维地洛的抗AD作用。试验结果表明,卡维地洛对AD患者的治疗结果与安慰剂相比无显著差异,未达到预期治疗终点。推测是由于卡维地洛的口服给药剂量较小,造成试验结果不理想。AD治疗药物需要通过血脑屏障进入大脑,并在脑内达到治疗浓度才能发挥作用。卡维地洛经过首关消除及血脑屏障后,达到病灶的药物浓度不足,难以发挥作用。
A型钾通道在海马锥体CA1神经元广泛分布,IA电流由以Kv4.2亚基为主的A型钾通道产生。在AD患者过度兴奋的神经元上,IA电流出现了明显的下调现象[44]。为验证卡维地洛构型差异是否对AD治疗存在影响,ZHOU等[45]R-卡维地洛进行了深入研究。与外消旋体卡维地洛相比,R-卡维地洛可以显著缩短RyR2的开放时间,减少了细胞线粒体中Ca2+的释放,有效地上调细胞膜上Kv4.2的表达,抑制神经元的过度兴奋,从而中断AD的正反馈循环。该课题组还在5xFAD+/-鼠实验中发现,当给予和R-卡维地洛相同剂量的外消旋体卡维地洛时,并不能改善5xFAD+/-鼠AD相关症状,这可能因为外消旋体中S-卡维地洛阻断心肌β受体,使R-卡维地洛在体内的有效浓度无法达到阈值,与YAO等[46]的临床试验结果相吻合。
该课题组的另一项AD小鼠模型行为学实验[46,47]表明,在AD小鼠发病前给予R-卡维地洛干预,可有效预防AD的发生;在AD小鼠发病时给药,同样可逆转AD小鼠神经元兴奋性增加的现象。同时,R-卡维地洛对发病晚期的AD小鼠仍有较好的治疗效果。研究表明R-卡维地洛可以通过上调海马CA1锥体神经元IA电流密度来实现对AD小鼠CA1锥体神经元兴奋性的钳制作用,防止其过度放电,改善神经突出的可逆性,增强长时程增益效应(LTP),提高海马基底区神经细胞的数量,逆转CA1区神经元的损伤,并在行为学研究中显著提高AD小鼠的认知和学习记忆能力,但R-卡维地洛并不能抑制AD小鼠脑组织中Aβ的积累[46]
GPCR作为最大的细胞膜表面受体家族,根据不同的开关分子——Gα亚基,可分为四类:Gαstimulatory (Gαs)、Gαinhibitory/olfactory (Gαi/o)、Gαq/11和Gα12/13,其中Gαs亚基占主导地位,而随着对GPCR的深入研究,发现其作用机制比传统的受体-配体作用模式更为复杂。某些配体会诱导受体选择性地与相应的GPCR亚基结合,优先传导下游众多信号通路中一支或激活G蛋白非依赖的β-arrestin通路中的一种,发挥不同的生物效应,这一现象称为“信号偏向性”(biased signaling)[48]。目前针对偏向β-arrestin的GPCR信号传导机制的假说主要包括多受体构象假说、受体磷酸化“条形码”假说和β-arrestin构象变化。在激动剂或抑制剂发挥作用后,会发生由G蛋白偶联受体激酶(GRKs)和β-arrestin两类蛋白介导的脱敏现象,从而阻断G蛋白与受体进一步结合发挥作用[49]。实验结果表明,β-arrestin与Gα亚基竞争磷酸化的受体位点,因此GRKs介导的受体磷酸化在β-arrestin的偏向性信号通路中起到重要作用。而卡维地洛不同于其他经典的β受体阻滞药,其选择性招募Gαi亚基而非Gαs亚基,且不需要β1受体磷酸化,募集Gαi亚基会促进并稳定形成的受体-Gαi复合体,进而激活β-arrestin的偏向性信号通路[50];而在其激活β2受体引起的β-arrestin偏向性信号通路中,通过19FNMR和特殊化学标记法发现,不需要Gαi亚基的募集,β2受体在Lys 263和Cys 265附近区域发生了明显的侧链重组现象,这也为多受体构象假说提供了证据[48]。基于β-arrestin在人体各组织器官广泛表达,利用卡维地洛介导的独特的β-arrestin偏向性信号通路,可以选择性调控组织细胞的表达和生物效应,减少因激活多条下游信号通路引起的不良反应,可能成为靶向治疗心脑血管疾病、肿瘤以及中枢神经疾病的潜在配体药物。
目前许多临床正使用的药物或曾作为临床试验的候选药物,正在被重新开发、研究,用于治疗新的适应证。近期,随着人们对卡维地洛药理作用研究的深入开展,发现其在抗氧化、抑制RyR2等方面具有显著作用并存在构型差异,推断其在治疗心衰、心律失常的临床应用外,还有更多潜在的应用价值有待发现。未来,基于对GCPR偏向性配体的深入研究,利用卡维地洛构型差异和独特的信号偏向性,可高选择性作用于病灶部位,减少不良生物信号产生的毒副作用,可能开发成为全新的靶向GPCR药物。
  • 2021年辽宁省教育厅面上项目(LJKZ0958)
  • 2022年辽宁省应用基础研究计划项目(2022JH2/101)
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2024年第43卷第3期
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doi: 10.14109/j.cnki.xyylc.2024.03.02
  • 接收时间:2022-07-20
  • 首发时间:2026-03-13
  • 出版时间:2024-03-25
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  • 收稿日期:2022-07-20
  • 录用日期:2023-04-06
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2021年辽宁省教育厅面上项目(LJKZ0958)
2022年辽宁省应用基础研究计划项目(2022JH2/101)
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    沈阳药科大学 基于靶点的药物设计与研究教育部重点实验室,辽宁 沈阳 110016

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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