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Abstract
Aldosterone, produced by the adrenals and under the control of plasma angiotensin and potassium levels, regulates hydromineral homeostasis and blood pressure. Here we report that the neuropeptide substance P (SP) released by intraadrenal nerve fibres, stimulates aldosterone secretion via binding to neurokinin type 1 receptors (NK1R) expressed by aldosterone-producing adrenocortical cells. The action of SP is mediated by the extracellular signal-regulated kinase pathway and involves upregulation of steroidogenic enzymes. We also conducted a prospective proof-of-concept, double blind, placebo-controlled clinical trial aimed to investigate the impact of the NK1R antagonist aprepitant on aldosterone secretion in healthy male volunteers (EudraCT: 2008-003367-40, ClinicalTrial.gov: NCT00977223). Participants received during two 7-day treatment periods aprepitant (125 mg on the 1st day and 80 mg during the following days) or placebo in a random order at a 2-week interval. The primary endpoint was plasma aldosterone levels during posture test. Secondary endpoints included basal aldosterone alterations, plasma aldosterone variation during metoclopramide and hypoglycaemia tests, and basal and stimulated alterations of renin, cortisol and ACTH during the three different stimulatory tests. The safety of the treatment was assessed on the basis of serum transaminase measurements on days 4 and 7. All pre-specified endpoints were achieved. Aprepitant decreases aldosterone production by around 30% but does not influence the aldosterone response to upright posture. These results indicate that the autonomic nervous system exerts a direct stimulatory tone on mineralocorticoid synthesis through SP, and thus plays a role in the maintenance of hydromineral homeostasis. This regulatory mechanism may be involved in aldosterone excess syndromes.
Highlights
Aldosterone, produced by the adrenals and under the control of plasma angiotensin and potassium levels, regulates hydromineral homeostasis and blood pressure
Whereas cortisol biosynthesis is dependent on the pituitary adrenocorticotrophic hormone (ACTH), the production of aldosterone, which plays a major role in the maintenance of hydromineral homeostasis and blood pressure regulation, is stimulated by the systemic renin angiotensin system (RAS) and plasma potassium[1]
TAC1 encoding substance P (SP) and neurokinin A (NKA) was expressed at high levels whereas TAC3 and TAC4 mRNAs, encoding respectively neurokinin B and endokinins, were unmeasurable or barely detectable (Fig. 1a)
Summary
Aldosterone, produced by the adrenals and under the control of plasma angiotensin and potassium levels, regulates hydromineral homeostasis and blood pressure. Aprepitant decreases aldosterone production by around 30% but does not influence the aldosterone response to upright posture These results indicate that the autonomic nervous system exerts a direct stimulatory tone on mineralocorticoid synthesis through SP, and plays a role in the maintenance of hydromineral homeostasis. The human adrenal cortex produces diverse steroid hormones including aldosterone, the end product of the mineralocorticoid synthesis pathway, which is released by the zona glomerulosa, and the glucocorticoid hormone cortisol secreted by the zona fasciculata. It is well established that, in patients receiving prolonged antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (ARA), plasma aldosterone levels tend to re-augment after an initial decrease[2,3] The mechanism of this phenomenon called “aldosterone breakthrough” remains unexplained. Aprepitant, a NK1R antagonist, reduces aldosterone production independently of the RAS
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