• 한국임상수의학회지
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• 제38권4호
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• pp.189-193
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• 2021

An 11-years old spayed female Persian chinchilla cat presented with acute onset of blindness from bilateral retinal detachment and systemic hypertension. On physical examination, the cat was tachycardic (240 beats/min) with a systolic blood pressure of around 250 mmHg. Clinical findings, blood works, urinalysis, thyroid function test, radiography, echocardiogram, and ultrasonography were performed to rule out underlying diseases. Organ injury induced by systemic hypertension including bilateral retinal detachment and left ventricular hypertrophy were confirmed by ultrasound. Based on these results, it was diagnosed as feline idiopathic hypertension with target organ damage (TOD). The cat was treated with a combination therapy using high doses of amlodipine, telmisartan, and atenolol. After the treatment, its hypertension and TOD were improved. This case showed that appropriate therapeutic management can help prevent TOD associated with feline hypertension.

• Kidney Research and Clinical Practice
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• 제34권1호
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• pp.53-56
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• 2015

MYH9-related disorder is an autosomal dominant disease caused by a mutation in the MYH9 gene, which encodes nonmuscle myosin heavy chain IIA (NMMHC-IIA). This disease is characterized by giant platelets, thrombocytopenia, granulocyte inclusion bodies, proteinuria, and high-pitch sensorineural deafness. Nephropathy has been observed in 30% of patients with MYH9-related disorder. The characteristic features are early onset proteinuria and rapidly progressing renal disorder. However, the prognosis of MYH9 nephropathy remains unclear. Herein, we describe a 36-year-old woman who presented with proteinuria and was diagnosed with MYH9 nephropathy via renal biopsy and gene analysis. Her proteinuria improved after administration of an angiotensin II receptor blocker, but was aggravated after changing to a calcium channel blocker.

• 생명과학회지
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• 제18권7호
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• pp.918-923
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• 2008

안지오텐신II 수용체(AT1 수용체)는 혈관수축과 체내 전해질이온 조절에 중요한 역할을 한다. AT1 수용체 길항제(ARB)는 고혈압 치료에 이용되며 최근에는 당뇨병을 포함한 대사질환에 효능이 있음이 알려져 있다. 이 연구에서는 ARB 처리 후 세포 내 인산화단백질에 인산화가 일어나는지를 antibody array를 이용하여 실험하였다. 아미노산세린 및 트레오닌에 인산화되는 단백질 6개, 티로신에 인산화되는 단백질 12개에 대한 항체를 선정하여 nitrocellulose membrane에 부착시켰다. AT1 수용체를 발현한 COS-1 세포에 로사틴(losartan)을 처리하였을 때 small GTPase인 RhoA의 세린 잔기에 인산화가 20% 증가함을 관찰하였다. RhoA는 세포골격의 재배열에 중요한 역할을 하며 세린 잔기에 인산화가 되면 활성이 억제된다. 본 연구결과로부터 ARB가 AT1 수용체에 의한 혈관수축을 억제할 뿐만 아니라 새로운 세포 신호룰 생성함을 알 수 있다.

• The Korean Journal of Physiology and Pharmacology
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• 제17권1호
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• pp.99-109
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• 2013

The aim of this study was to determine whether fimasartan, a newly developed $AT_1$ receptor blocker, can affect the CA release in the isolated perfused model of the adrenal medulla of spontaneously hypertensive rats (SHRs). Fimasartan (5~50 ${\mu}M$) perfused into an adrenal vein for 90 min produced dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high $K^+$ (56 mM, a direct membrane depolarizer), DMPP (100 ${\mu}M$) and McN-A-343 (100 ${\mu}M$). Fimasartan failed to affect basal CA output. Furthermore, in adrenal glands loaded with fimasartan (15 ${\mu}M$), the CA secretory responses evoked by Bay-K-8644 (10 ${\mu}M$, an activator of L-type $Ca^{2+}$ channels), cyclopiazonic acid (10 ${\mu}M$, an inhibitor of cytoplasmic $Ca^{2+}$-ATPase), and veratridine (100 ${\mu}M$, an activator of $Na^+$ channels) as well as by angiotensin II (Ang II, 100 nM), were markedly inhibited. In simultaneous presence of fimasartan (15 ${\mu}M$) and L-NAME (30 ${\mu}M$, an inhibitor of NO synthase), the CA secretory responses evoked by ACh, high $K^+$, DMPP, Ang II, Bay-K-8644, and veratridine was not affected in comparison of data obtained from treatment with fimasartan (15 ${\mu}M$) alone. Also there was no difference in NO release between before and after treatment with fimasartan (15 ${\mu}M$). Collectively, these experimental results suggest that fimasartan inhibits the CA secretion evoked by Ang II, and cholinergic stimulation (both nicotininc and muscarinic receptors) as well as by membrane depolarization from the rat adrenal medulla. It seems that this inhibitory effect of fimasartan may be mediated by blocking the influx of both $Na^+$ and $Ca^{2+}$ through their ion channels into the rat adrenomedullary chromaffin cells as well as by inhibiting the $Ca^{2+}$ release from the cytoplasmic calcium store, which is relevant to $AT_1$ receptor blockade without NO release.

• 한국임상약학회지
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• 제23권4호
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• pp.322-326
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• 2013

Purpose: Telmisartan, an angiotensin receptor blocker has been known to be a potent blocker of both CYP2J2 and P-glycoprotein (P-gp) in vitro. This study aims to investigate the drug-drug interactions between telmisartan and ebastine, a CYP2J2 and P-gp substrate in rats. Method: Ebastine (10 mg/kg) was orally given in the presence and absence of telmisartan (4 mg/kg, p.o.). Heparinized blood was serially taken and the plasma concentrations of ebastine and its three metabolites (hydroxyebastine, carebastine and desalkylebastine) were determined using LC-MS/MS, and their pharmacokinetic parameters were compared. Results: Peak concentrations ($C_{max}$) and AUC of ebastine were significantly (p<0.05) increased in the presence of telmisartan by 2.1 and 1.9 times, respectively. While $C_{max}$ of hydroxyebastine was significantly increased by 1.9 times, the half-life of hydroxyebasteine was decreased significantly with telmisartan (p<0.05). There was no change in the pharmacokinetic parameters of carebastine, the active metabolite of ebastine, and desalkylebastine was not detected in plasma. The systemic exposure of ebastine was significantly augmented by telmisartan, indicating that telmisartan may enhance the absorption of ebastine by blocking P-gp. Conclusion: Although telmisartan may also partially contribute to inhibit the biotransformation to hydroxyebastine, the inhibitory action seemed to be overridden by the enhancement of absorption, because the generation of hydroxyebastine was not diminished. In spite of such interactions between telmisartan and ebastine, no clinical consequence could be expected due to no significant change of the active metabolite, carebastine.

• 한국임상약학회지
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• 제23권4호
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• pp.316-321
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• 2013

Purpose: Atorvastatin, a HMG-CoA reductase inhibitor is widely prescribed in hyperlipidemic patients and telmisartan, an angiotensin receptor blocker is frequently used in the treatment of hypertension. Both drugs are substrates of organic anion transporting polypeptide (OATP) expressed in basolateral membrane in the liver, and undergo high first pass metabolism. Therefore, OATP-mediated hepatic uptake is important for disposition and metabolism of these drugs. The present study was designed to investigate the pharmacokinetic interactions between atorvastatin and telmisartan in rats. Method: Young adult SD rats were divided into three groups (n=6, each) and atorvastatin (10 mg/kg) and telmisartan (4 mg/kg) were orally given alone and together. Heparinized blood was serially taken and plasma concentrations of both drugs were measured using HPLC-MS/MS. Pharmacokinetic parameters of two drugs were calculated. Results: No significant pharmacokinetic change was found except a delay of time to peak of telmisartan when administered with atorvastatin. Each drug at the present dosage seemed to be insufficient to alter the pharmacokinetic parameters of its counterpart drug. Conclusion: Conclusively, co-administration of atorvastatin and telmisartan may lead to negligible clinical consequences.

• Biomolecules & Therapeutics
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• 제28권5호
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• pp.423-430
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• 2020

Telmisartan is an angiotensin-II receptor blocker and acts as a selective modulator of peroxisome proliferator-activated receptor gamma (PPARγ). Several studies have demonstrated that telmisartan ameliorates depression and memory dysfunction and reduces brain inflammation. We hypothesized that the beneficial effects of telmisartan on brain could be due to modulation of the blood-brain barrier (BBB) function. Here, we examined the effect of telmisartan on tumor necrosis factor alpha (TNF-α)-induced expression of intercellular adhesion molecule 1 (ICAM-1) which plays an important role in leukocyte transcytosis through the BBB. Telmisartan blocked TNF-α-induced ICAM-1 expression and leukocyte adhesion in U87MG human glioma cells but showed no effect on human brain microvascular endothelial cells. In U87MG cells, a PPAR antagonist, GW9662 did not block the effect of telmisartan on ICAM1 expression but rather potentiated. Moreover, GW9662 caused no change in TNF-α-induced ICAM-1 expression, suggesting no implication of PPARγ in the telmisartan effect. Further studies showed that telmisartan blocked TNF-α-induced activation of c-Jun N-terminal kinase (JNK), extracellular signal-regulated kinase 1/2 (ERK1/2), p38, and nuclear factorkappa B (NF-κB). In contrast, inhibitors of JNK, ERK1/2 and NF-κB but not p38, blocked ICAM-1 expression induced by TNF-α. Thus, our findings suggest that the beneficial effect of telmisartan is likely due to the reduction of astrocytic ICAM1 expression and leukocytes adhesion to astrocytes, and that this response was mediated by the inhibition of JNK/ERK1/2/NF-κB activation and in the PPAR-independent manner. In conclusion, this study enhances our understanding of the mechanism by which telmisartan exerts the beneficial brain function.

• 한국임상약학회지
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• 제26권3호
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• pp.213-219
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• 2016

Objective: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. Methods: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. Results: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). Conclusion: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.

• Journal of Yeungnam Medical Science
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• 제36권1호
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• pp.26-35
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• 2019

Background: Dysregulation of hepatic glucose production (HGP) contributes to the development of type 2 diabetes mellitus. Telmisartan, an angiotensin II type 1 receptor blocker (ARB), has various ancillary effects in addition to common blood pressure-lowering effects. The effects and mechanism of telmisartan on HGP have not been fully elucidated and, therefore, we investigated these phenomena in hyperglycemic HepG2 cells and high-fat diet (HFD)-fed mice. Methods: Glucose production and glucose uptake were measured in HepG2 cells. Expression levels of phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase ${\alpha}$ ($G6Pase-{\alpha}$), and phosphorylation levels of insulin receptor substrate-1 (IRS-1) and protein kinase C ${\zeta}$ ($PKC{\zeta}$) were assessed by western blot analysis. Animal studies were performed using HFD-fed mice. Results: Telmisartan dose-dependently increased HGP, and PEPCK expression was minimally increased at a $40{\mu}M$ concentration without a change in $G6Pase-{\alpha}$ expression. In contrast, telmisartan increased phosphorylation of IRS-1 at Ser302 ($p-IRS-1-Ser^{302}$) and decreased $p-IRS-1-Tyr^{632}$ dose-dependently. Telmisartan dose-dependently increased $p-PKC{\zeta}-Thr^{410}$ which is known to reduce insulin action by inducing IRS-1 serine phosphorylation. Ectopic expression of dominant-negative $PKC{\zeta}$ significantly attenuated telmisartan-induced HGP and $p-IRS-1-Ser^{302}$ and -inhibited $p-IRS-1-Tyr^{632}$. Among ARBs, including losartan and fimasartan, only telmisartan changed IRS-1 phosphorylation and pretreatment with GW9662, a specific and irreversible peroxisome proliferator-activated receptor ${\gamma}$ ($PPAR{\gamma}$) antagonist, did not alter this effect. Finally, in the livers from HFD-fed mice, telmisartan increased $p-IRS-1-Ser^{302}$ and decreased $p-IRS-1-Tyr^{632}$, which was accompanied by an increase in $p-PKC{\zeta}-Thr^{410}$. Conclusion: These results suggest that telmisartan increases HGP by inducing $p-PKC{\zeta}-Thr^{410}$ that increases $p-IRS-1-Ser^{302}$ and decreases $p-IRS-1-Tyr^{632}$ in a $PPAR{\gamma}$-independent manner

• Childhood Kidney Diseases
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• 제14권1호
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• pp.1-9
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• 2010

긴 잔여 수명을 가진 소아-청소년기에 발생한 만성 콩팥병의 진행을 억제하는 것은 매우 중요하다. 콩팥 기능의 변화는 공식을 이용하여 혈청 크레아틴이나 시스타틴 C 치를 이용한 사구체 여과율의 추정치를 계산하는 것이 비교적 정확하고 편리하다. 고혈압과 단백뇨는 엄격하게 조절되어야 하며 빈혈은 에리트로포이에틴으로 교정되어야 한다. 혈압이 정상인 경우에도 특별한 금기사항이 없는 한 ACE 억제제나 안지오텐신 수용체 차단제를 사용하는 것이 필요하나 부작용의 발생에 주의할 필요가 있다. 만성 콩팥병의 진행 억제를 위한 노력은 만성 콩팥병이 확인되는 대로 가능한 일찍 시작되어야 하며 콩팥 이식을 받을 때까지 잔여 신기능이 남아 있는 한 계속되어야 한다. 온라인 한국 소아 만성 콩팥병 등록 시스템이 만성 콩팥병의 진료에 도움을 준다.