endothelin-1 and pirfenidone

Fibrotic diseases are a significant global burden for which there are limited treatment options. The effector cells of fibrosis are activated fibroblasts called myofibroblasts, a highly contractile cell type characterized by the appearance of α-smooth muscle actin stress fibers. The underlying mechanism behind myofibroblast differentiation and persistence has been under much investigation and is known to involve a complex signaling network involving transforming growth factor-β, endothelin-1, angiotensin II, CCN2 (connective tissue growth factor), and platelet-derived growth factor. This review addresses the contribution of these signaling molecules to cardiac fibrosis.

Topics: Angiotensin II; Angiotensin II Type 1 Receptor Blockers; Animals; Anti-Inflammatory Agents; Arrhythmias, Cardiac; Atrophy; Cicatrix; Connective Tissue Growth Factor; Endothelin Receptor Antagonists; Endothelin-1; Fibrosis; Humans; Hypoxia; Models, Cardiovascular; Molecular Targeted Therapy; Myocardium; Myofibroblasts; Platelet-Derived Growth Factor; Pyridones; Rats; Signal Transduction; Transforming Growth Factor beta

The concept of reversing chronic kidney disease (CKD) has been intensively researched over the past decade. Indeed, as the prevalence of end-stage renal disease is constantly on the rise, the lack of established antifibrotic therapies is a considerable unmet need in clinical practice. Now, the possibility of effective antifibrotic treatment has been established in experimental models of CKD and multiple antifibrotic compounds-in kidney disease, as well as in fibrotic diseases of the skin, liver and lung-are being assessed in clinical trials. These strategies target various components of the fibrotic pathway, from signalling molecules that include transforming growth factor-β, phosphatidylinositide 3-kinase and chemokines to microRNAs. Here, we discuss therapeutic concepts to inhibit or even reverse chronic kidney injury and review the leading candidate antifibrotic drugs to be introduced to clinical use.

Topics: Anti-Inflammatory Agents; Bone Morphogenetic Protein 7; Connective Tissue Growth Factor; Disease Progression; Endothelin-1; Epigenesis, Genetic; Extracellular Matrix; Fibroblasts; Fibrosis; Humans; Kidney; Kidney Diseases; Kidney Failure, Chronic; Microcirculation; Phosphodiesterase Inhibitors; Pyridones; Transforming Growth Factor beta

Treatment of chronic kidney disease (CKD) can slow its progression to end-stage renal disease (ESRD). However, the therapies remain limited. Blood pressure control using angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) has the greatest weight of evidence. Glycemic control in diabetes seems likely to retard progression. Several metabolic disturbances of CKD may prove to be useful therapeutic targets but have been insufficiently tested. These include acidosis, hyperphosphatemia, and vitamin D deficiency. Drugs aimed at other potentially damaging systems and processes, including endothelin, fibrosis, oxidation, and advanced glycation end products, are at various stages of development. In addition to the paucity of proven effective therapies, the incomplete application of existing treatments, the education of patients about their disease, and the transition to ESRD care remain major practical barriers to better outcomes.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Diabetes Mellitus, Type 2; Disease Progression; Endothelin-1; Humans; Hypertension; Kidney Failure, Chronic; Oleanolic Acid; Pyridones; Renal Insufficiency, Chronic; Renin-Angiotensin System

Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrosing disease of the distal air spaces of the lung of unknown aetiology. IPF is usually fatal with a median survival of < 3 years. There are currently no effective pharmacotherapeutic agents for the treatment of IPF. In this review, unifying concepts on the pathogenesis of IPF based on understanding of host responses to tissue injury are presented. These host responses involve tightly regulated and contextually orchestrated inflammatory and repair processes. Dysregulation of either of these processes can lead to pathological outcomes. Fibrosis results from an exaggerated or dysregulated repair process that proceeds 'uncontrolled' even after inflammatory responses have subsided. Disease heterogeneity may arise when inflammation and repair are in different (dys)regulatory phases, thus accounting for regional disparity. Usual interstitial pneumonia (UIP), the histopathological correlate of clinical IPF, represents a more fibrotic tissue reaction pattern and for which anti-inflammatory agents are ineffective. Emerging 'antifibrotic' drugs and strategies for UIP/IPF are discussed. The importance of accurately phenotyping a highly heterogeneous disease process that may require individualised and 'combined' therapies is emphasised.

Topics: Acetylcysteine; Animals; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Connective Tissue Growth Factor; Eicosanoids; Endothelin-1; Humans; Immediate-Early Proteins; Intercellular Signaling Peptides and Proteins; Interferon-gamma; Molybdenum; Protein Kinase Inhibitors; Proteins; Pulmonary Fibrosis; Pyridones; Recombinant Proteins; Relaxin; Renin-Angiotensin System; Tumor Necrosis Factor-alpha