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Modulação terapêutica das células percursoras do endotélio por anti-hipertensores
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A medula óssea contém um subtipo particular de células progenitoras com capacidade para se diferenciarem em células endoteliais. As células percursoras de endotélio (EPCs) desempenham um papel-chave na manutenção da homeostasia endotelial e promovem a reparação vascular. A concentração normal de EPCs em circulação é considerada um marcador de saúde vascular.
O papel das EPCs na biologia vascular começa a ser melhor caracterizado, no entanto a sua função na hipertensão arterial (HTA) encontra-se ainda incompletamente estudada. Nomeadamente, os efeitos da terapêutica anti-hipertensora na biologia das próprias EPCs permanece pouco caracterizado.
Partindo destas premissas, nesta revisão sistematizada foi realizada uma pesquisa no PUBMED escrutinando a associação entre EPCs e o nome de classes de anti- hipertensores. Foram obtidos 181 artigos e após aplicação de critérios de elegibilidade foram selecionados 23 artigos, 4 dos quais excluídos após segunda revisão do artigo completo.
Classes como os inibidores da enzima de conversão da angiotensina, os antagonistas dos recetores da angiotensina II e os bloqueadores dos canais de cálcio demonstraram aumentar o número e a capacidade funcional das EPCs (mobilização, proliferação, diminuição da apoptose, resistência ao stress oxidativo e capacidade formadora de colónias). Já os diuréticos e os bloqueadores beta-adrenérgicos parecem não ter efeito modulador benéfico neste âmbito. Os nitratos orgânicos apresentam um efeito intermédio, dependendo do fármaco em questão.
Serão necessários, mais estudos, com critérios metodológicos mais homogéneos para confirmar as observações supracitadas, podendo vir futuramente a serem aplicados eventuais protocolos de atuação terapêutica, tendo em consideração os efeitos pleiotrópicos destas células.
Bone marrow contains a particular subtype of progenitor cells capable of differentiating into endothelial cells. Endothelial precursor cells (EPCs) play a key role in maintaining endothelial homeostasis and promote vascular repair. The normal concentration of circulating EPCs is a vascular health marker. The role of EPCs in vascular biology begins to be better characterized, however its role in arterial hypertension (AHT) is still incompletely studied. Notably, the effects of antihypertensive therapy on the biology of EPCs themselves remain poorly characterized. Based on these premises, in this systematized review a research was done in the PUBMED scrutinizing the association between EPCs and the name of antihypertensive classes. 181 articles were obtained and after application of eligibility criteria, 23 articles were selected, 4 of which were excluded after a second review of the complete article. Classes such as angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium channel blockers have demonstrated increased functional capacity of EPCs (mobilization, proliferation, increased apoptosis, resistance to oxidative stress and formative capacity of colonies). Diuretics and beta-adrenergic blockers, however, do not appear to have a beneficial modulatory effect in this context. Nitrates should have an intermediate effect depending on the drug in question. Further studies will be needed with more homogeneous methodological criteria to confirm the observations mentioned above, and future protocols for therapeutic action may be applied in future, taking into account the pleiotropic effects of these cells.
Bone marrow contains a particular subtype of progenitor cells capable of differentiating into endothelial cells. Endothelial precursor cells (EPCs) play a key role in maintaining endothelial homeostasis and promote vascular repair. The normal concentration of circulating EPCs is a vascular health marker. The role of EPCs in vascular biology begins to be better characterized, however its role in arterial hypertension (AHT) is still incompletely studied. Notably, the effects of antihypertensive therapy on the biology of EPCs themselves remain poorly characterized. Based on these premises, in this systematized review a research was done in the PUBMED scrutinizing the association between EPCs and the name of antihypertensive classes. 181 articles were obtained and after application of eligibility criteria, 23 articles were selected, 4 of which were excluded after a second review of the complete article. Classes such as angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium channel blockers have demonstrated increased functional capacity of EPCs (mobilization, proliferation, increased apoptosis, resistance to oxidative stress and formative capacity of colonies). Diuretics and beta-adrenergic blockers, however, do not appear to have a beneficial modulatory effect in this context. Nitrates should have an intermediate effect depending on the drug in question. Further studies will be needed with more homogeneous methodological criteria to confirm the observations mentioned above, and future protocols for therapeutic action may be applied in future, taking into account the pleiotropic effects of these cells.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Células progenitoras de endotélio Hipertensão arterial Anti-hipertensores Modulação terapêutica