Proteomic and mechanistic analysis of spironolactone in patients at risk for HF

Ferreira, J. P. et al. (2021) Proteomic and mechanistic analysis of spironolactone in patients at risk for HF. JACC: Heart Failure, 9(4), pp. 268-277. (doi: 10.1016/j.jchf.2020.11.010) (PMID:33549556)

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Objectives: This study sought to further understand the mechanisms underlying effect of spironolactone and assessed its impact on multiple plasma protein biomarkers and their respective underlying biologic pathways. Background: In addition to their beneficial effects in established heart failure (HF), mineralocorticoid receptor antagonists may act upstream on mechanisms, preventing incident HF. In people at risk for developing HF, the HOMAGE (Heart OMics in AGEing) trial showed that spironolactone treatment could provide antifibrotic and antiremodeling effects, potentially slowing the progression to HF. Methods: Baseline, 1-month, and 9-month (or last visit) plasma samples of HOMAGE participants were measured for protein biomarkers (n = 276) by using Olink Proseek-Multiplex cardiovascular and inflammation panels (Olink, Uppsala, Sweden). The effect of spironolactone on biomarkers was assessed by analysis of covariance and explored by knowledge-based network analysis. Results: A total of 527 participants were enrolled; 265 were randomized to spironolactone (25 to 50 mg/day) and 262 to standard care (“control”). The median (interquartile range) age was 73 (69 to 79) years, and 26% were female. Spironolactone reduced biomarkers of collagen metabolism (e.g., COL1A1, MMP-2); brain natriuretic peptide; and biomarkers related to metabolic processes (e.g., PAPPA), inflammation, and thrombosis (e.g., IL17A, VEGF, and urokinase). Spironolactone increased biomarkers that reflect the blockade of the mineralocorticoid receptor (e.g., renin) and increased the levels of adipokines involved in the anti-inflammatory response (e.g., RARRES2) and biomarkers of hemostasis maintenance (e.g., tPA, UPAR), myelosuppressive activity (e.g., CCL16), insulin suppression (e.g., RETN), and inflammatory regulation (e.g., IL-12B). Conclusions: Proteomic analyses suggest that spironolactone exerts pleiotropic effects including reduction in fibrosis, inflammation, thrombosis, congestion, and vascular function improvement, all of which may mediate cardiovascular protective effects, potentially slowing progression toward heart failure. (HOMAGE [Bioprofiling Response to Mineralocorticoid Receptor Antagonists for the Prevention of Heart Failure]; NCT02556450)

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Ferreira, Mr Joao Pedro and Pellicori, Dr Pierpaolo
Authors: Ferreira, J. P., Verdonschot, J., Wang, P., Pizard, A., Collier, T., Ahmed, F. Z., Brunner-La-Rocca, H.-P., Clark, A. L., Cosmi, F., Cuthbert, J., Díez, J., Edelmann, F., Girerd, N., González, A., Grojean, S., Hazebroek, M., Khan, J., Latini, R., Mamas, M. A., Mariottoni, B., Mujaj, B., Pellicori, P., Petutschnigg, J., Pieske, B., Rossignol, P., Rouet, P., Staessen, J. A., Cleland, J. G.F., Heymans, S., and Zannad, F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JACC: Heart Failure
ISSN (Online):2213-1787
Published Online:03 February 2021
Copyright Holders:Copyright © 2021 American College of Cardiology Foundation
First Published:First published in JACC: Heart Failure 9(4): 268-277
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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