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XIII International Symposium Heart Failure & Co. New perspectives in the therapy with PPAR- γ agonists. Carlo Maria Rotella, Ilaria Dicembrini. Napoli, 12-13 aprile 2013. Properties of PPAR- γ. PPAR- γ ligands. Adverse events associated with PPAR- γ agonists.
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XIII International Symposium Heart Failure & Co. New perspectives in the therapy withPPAR-γagonists. Carlo Maria Rotella, Ilaria Dicembrini Napoli, 12-13 aprile 2013
Adverse events associated with PPAR-γ agonists • Chronic heart failure/oedema and fluid retention Increasing sodium retention and plasma volume expansion due to PPAR-γ in the epithelium of the renal collecting ducts Act synergistically with insulin to increase sympathetic nervous activity, which causes arterial vasodilation leading to sodium retention Change in endothelial permeability leading to extracellular fluid increase Similarity in thiazolidinediones to the dihyrdopyridine type of calcium-channel blockers, which exert their effect through L-type calcium channels and cause increased fluid permeability • Weight gain Redistribution of fat from central to peripheral sites Adipocyte hyperplasia, fluid retention and decreased glycosuria Genetic factors • Bone fractures Associated with a loss of bone density Decreased osteoblast differentiation: PPAR-γ signals preferential differentiation of mesenchymal cells to adipocytes rather than osteoblasts, thereby reducing bone formation and mass Increased osteoclast formation
Reported meta-analysis about the effct of TZD on cardiovascular risk in type 2 Diabetes
PPAR- γ independent mechanisms:Cardiomycocytes protective effects induced by Pioglitazone
PPAR- α dependent mechanisms:Cardiomycocytes protective effects induced by Pioglitazone Pioglitazone limits myocardial infarct size, activates Akt, and upregulates cPLA2 and COX-2 in a PPAR-γ-independent manner. Basic Res Cardiol. 2011;106(3):431-46.
Control animals Pioglitazone-treated animals Hippocampus Temporal Cortex
PPAR-γ ligands & Sepsis On a mouse model of sepsis induced by a bacterial endotoxin , PPAR-γ like a anti-inflammatory mediator by inhibiting early and late proinflammatory cytokines such as TNF-α, IL-6, iNOS, and HMGB1.
PPAR-γ ligands & Cancer 1. Cellgrowth and proliferation 3. TGF-βpathway 2. Inflammatorypathways EMT= epithelial mesenchymal transition A.K. Reka et al. Lung Cancer 72 (2011) 154–159
PPAR-γ ligands & Cancer 4. Preventcytoxicityinducedbyplatinumdrugs, 5. Synergywithcisplatin and paclitaxel, 6. Facilitationof the epidermalgrowthfactorreceptorsignaling (gefitinib), 7.Potentiation of HDAC inhibitor (phenylbutirate) A.K. Reka et al. Lung Cancer 72 (2011) 154–159
PPAR-γ agonists & Cancer Retrospectiveanalysisof more than 80.000 TZD userscomparedtononusersafteradjustingforconfoundingvariables: 33% reduction in lungcancerrisk.