Evidence from cell, animal, and human studies demonstrates that α1-adrenergic receptors mediate adaptive and protective effects in the heart. These effects may be particularly important in chronic heart failure, when catecholamine levels are elevated and β-adrenergic receptors are down regulated and dysfunctional. This review summarizes these data and proposes that selectively activating α1-adrenergic receptors in the heart may represent a novel and effective way to treat heart failure.
Keywordsalpha-1-adrenergic receptors; cardiac myocytes; heart failure; drug development
Description of α1-ARsThe neurohormonal alterations of heart failure (HF) are characterized by marked elevations in sympathetic catecholamines, norepinephrine (NE) and epinephrine (EPI) [1]. NE and EPI activate two main classes of myocardial adrenergic receptors (ARs), alpha-1-ARs (α1-ARs) and beta-ARs (β-ARs). The most abundant cardiac AR is the β1-AR, though there are also smaller but functionally important populations of β2-and α1-ARs. All ARs are prototypical G-protein coupled receptors (GPCRs) with seven transmembrane domains, though they differentially activate Gα subunits: β-ARs couple predominantly to Gs, and α1-ARs to Gq, although β2-and α1-ARs can also couple to Gi.Correspondence: Paul C. Simpson MD, VA Medical Center (111-C-8), 4150 Clement St., San Francisco, CA 94121 USA, Phone: (415) 221-4810 x3200, FAX: (415) 379-5570, paul.simpson@ucsf.edu. 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.
DISCLOSURESA patent application is submitted to use α1-agonist compounds as treatment.
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NIH-PA Author ManuscriptAcute activation of β1-ARs increases heart rate and myocardial contractility. However excessive chronic stimulation of cardiac β1-ARs, as with elevated catecholamines in HF, mediates harmful processes, including cell death, fibrosis, and adverse remodeling [2][3][4][5][6][7][8][9]. Interestingly, recent investigations suggest that myocardial β2-ARs might mitigate the harm associated with chronic β1-AR activation (article by Talan et al in this issue, and [10,11]). Nevertheless, drugs that block the activation of β-ARs (β-blockers) reduce HF morbidity and mortality and have become a cornerstone of HF therapy [12]. α1-ARs in the heart have been the subject of less intensive investigation, but multiple lines of evidence define adaptive and protective roles for cardiac α1-ARs (Tables 1-3) that contrast sharply with the toxic effects of excessive chronic β-AR activation [9].α1-ARs exist as three distinct molecular subtypes, na...