Rima Braukylienė1, Grytė Ramantauskaitė2, Ali Aldueli1, Vaiva Lesauskaitė3, Sandrita Šimonytė3, Diana Žaliaduonytė1,2
1Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
2Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
3Laboratory of molecular Cardiology, The Institute of Cardiology at Lithuanian University of Health Sciences, Kaunas, Lithuania
Abstract
Acute myocardial infarction (AMI) is one of the most common cardiovascular diseases. According to the World Health organisation, it is one of the most common causes for premature death in developed countries. During myocardial infarction, both neuroendocrine and autonomic nervous systems are activated in order to maintain homeostasis during stress. The hypothalamic – pituitary – adrenal axis and cortisol (a stress induced hormone) play an essential role in this process. An overproduction and increase in blood level of cortisol occurs following AMI event. In different tissues of the body, cortisol interacts with mineralocorticoid and glucocorticoid receptors, however, its efficacy varies between tissue types. In cardiomyocytes, during acute myocardial injury, mineralocorticoid receptors are activated by reactive oxygen forms and as a consequence, their activity increases by intensifying cortisol binding to corresponding receptors, causing competition with aldosterone. Increased mineralocorticoid receptors activity and interaction with cortisol is harmful for cardiomyocytes – acting through genomic and non-genomic pathways, this process induces inflammation, fibrosis, hypertrophy, and destruction of cardiomyocytes. This process was also observed in mice models, developed in order to assess the role of mineralocorticoid and glucocorticoid receptors’ in the remodeling process.
Aim: to analyse studies about the effect of cortisol and mineralocorticoid receptors interaction on cardiac function and remodeling in patients with acute myocardial infarction.
Methods: the search of literature sources was carried out using these databases: Pubmed, ClinicalKey, Cohrane, ScienceDirect. Certain keywords and their combinations were used to find specific medical articles. The newest articles on the topic were evaluated and analyzed. A summarized analysis of scientific articles is presented in this review.
Conclusions: as a consequence of cortisol and mineralocorticoid receptors interaction heart remodeling process accelerates and heart failure occurs, the prognosis and outcomes of the patients with AMI worsen. The modulation of mineralocorticoid and glucocorticoid receptor activity could be the future goal for therapeutic targeting in order to reduce the effect of these processes on the cardiac function and remodeling.
Keywords: acute myocardial infarction, neuroendocrine regulation, cortisol, glucocorticoid receptor, mineralocorticoid receptor, heart remodeling.