The main clinical manifestations of advanced chronic heart failure (CHF), e.g. in dilated cardiomyopathy (DCM), are reduced systolic and diastolic functions, increased arterial elastance and arterio-ventricular uncoupling, accompanied and exacerbated by an excessive sympathetic activation and extensive abnormalities in the βAR signaling. Loss of cardiomyocytes due to apoptosis is one mechanism that undoubtedly contributes to cardiac remodeling and functional deterioration associated with dilated cardiomyopathy (DCM). Research during the last decade on the single cardiomyocyte level strongly suggested that selective stimulation of β 1 AR activates the proapoptotic signaling pathways, while selective stimulation of β 2 AR is antiapoptotic, but its precise mechanisms remain to be elucidated. Extensive research in the rat model of DCM following induction of myocardial infarction (MI) showed that prolonged treatment with of β 2 AR agonist, fenoterol, in combination with a β 1 AR blocker, metoprolol, is more effective than β 1 AR blocker alone and as effective as β 1 AR blocker with ACE inhibitor with respect to survival and cardiac remodeling. This combined regimen of β 2 AR agonists and a β 1 AR blocker might be considered for clinical testing as alternative or adjunct therapy to currently acceptable CHF arsenal.
KeywordsChronic heart failure; beta adrenergic receptors; β 2 adrenergic receptor agonists; cardiac remodeling β 2 adrenergic receptor (AR), one of the first receptors identified by radioligand bindings, belongs to a family of G-protein-coupled receptors and plays important parts in pulmonary and cardiovascular physiology. Additionally, it is also expressed in skeletal muscles, digestive system, eye, uterus, and urinary bladder [1]. β 2 adrenergic receptor (AR) agonists are a necessary part of a long established treatment regimen for bronchial asthma and other pulmonary obstructive conditions [for review see 2,3]. The most often used drugs are a short-acting preparation, albuterol and long-acting, salmeterol. Numerous animal studies indicate that chronic stimulation of β 2 AR at high Corresponding author: Mark I Talan, National Institute on Aging, Intramural Research Program, Gerontology Research Center, 5600 Nathan Shock Drive, Baltimore, MD 21224-6825, Tel: (410) Fax: (410) 558-8150, talanm@grc.nia.nih.gov. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. [5,6]. Clenbuterol is also widely used as performance enhancer, especially by body builders [7]. Here we review potential therapeutic applications of β 2 AR agonists for chronic heart failure (CHF).
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