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Mineralocorticoid Receptor and Aldosterone: From Hydro-saline Metabolism to Metabolic Diseases

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Hydro Saline Metabolism

Part of the book series: Endocrinology ((ENDOCR))

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Abstract

The steroid hormone aldosterone regulates electrolyte homeostasis and blood pressure by activating mineralocorticoid receptor (MR) in in the distal nephron. In the last 10 years, a number of preclinical studies has shown that MR is expressed also in extra-renal tissues such as heart, adipose tissue and vasculature, providing strong evidence that dysregulated extra-renal MR activation contributes to the development of hypertension, obesity, insulin resistance and heart disease. Notably, mice with overexpression of adipose tissue-specific MR display obesity and typical features of metabolic syndrome. On the other hand, preclinical studies in mice prone to develop obesity, atherosclerosis, heart failure and insulin resistance have observed that pharmacological blockade of MR is able to prevent development of such derangements. Increased circulating aldosterone levels have been observed in patients with obesity and metabolic syndrome, suggesting that overactivation of MR may have a causal role in the occurrence and/or progression of metabolic and cardiovascular dysfunctions also in humans. MR antagonist (MRA) treatment has shown remarkable efficacy in pathological conditions such as chronic HF, primary aldosteronism and chronic kidney disease, although clinical use of these drugs has been limited by the occurrence of hyperkalemia and other side effects. The novel non-steroidal MRAs provide reduced risk of hyperkalemia and represent attractive tools to treat diabetic patients with the cardio-renal syndrome.

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Acknowledgments

This work was supported by the Italian Ministry of Health (Ricerca Corrente), and by MIUR (Progetti di Ricerca di Interesse Nazionale 2017–project code 2017A5TXC3–to MC, Work Package Leader).

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Authors and Affiliations

  1. Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy

    Andrea Armani & Massimiliano Caprio

  2. Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy

    Andrea Armani & Massimiliano Caprio

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  1. Andrea Armani
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  2. Massimiliano Caprio
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Correspondence to Massimiliano Caprio .

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Editors and Affiliations

  1. Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy

    Massimiliano Caprio

  2. Université Paris Cité, PARCC, Inserm, Paris, France

    Fabio Luiz Fernandes-Rosa

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Armani, A., Caprio, M. (2023). Mineralocorticoid Receptor and Aldosterone: From Hydro-saline Metabolism to Metabolic Diseases. In: Caprio, M., Fernandes-Rosa, F.L. (eds) Hydro Saline Metabolism. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-27119-9_14

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  • DOI: https://doi.org/10.1007/978-3-031-27119-9_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-27118-2

  • Online ISBN: 978-3-031-27119-9

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