Nutriuretic Peptides, the Renin-Angiotensin System, and Metabolic Risk in Obesity

描述（由申请人提供）：肥胖是心血管疾病（CVD）发病率和死亡率的重要原因。肥胖人群心血管疾病风险的一个基本调节因素是胰岛素抵抗和代谢危险因素（葡萄糖耐受不良、血脂异常和高血压）的发展。然而，肥胖的代谢风险是不同的。 RAAS 的激活是肥胖的一个关键特征，可以通过减肥来逆转。激活的 RAAS 会触发 NP 的释放，这是重要的反调节激素。出乎意料的是，肥胖个体中的 NP 水平降低而不是升高，这表明肥胖与“钠尿障碍”相关，RAAS 和 NP 途径对葡萄糖代谢和脂肪细胞功能产生重要且相反的影响。此外，药物 RAAS 阻断与糖尿病发病率降低相关。我们假设肥胖个体中肾素-血管紧张素-醛固酮系统（RAAS）激活和利钠肽（NP）下调的不平衡导致代谢风险的异质性。我们建议通过获得 RAAS（血浆肾素、血管紧张素转换酶、醛固酮）和 NP（N 端 B 型利钠肽前体、N 端心房利钠肽前体、cGMP）生物标志物的系列测量值，并将其与大型社区队列（弗雷明汉心脏研究 [FHS] 第 3 代和少数 Omni 第 2 代参与者）中代谢危险因素的纵向追踪联系起来，来检验我们的假设。我们的具体目标是 (1) 检查肥胖和纵向体重变化（超过 4 年）与循环 RAAS/NP 生物标志物的关联； (2) 将 RAAS/NP 生物标志物与发生代谢性状的风险联系起来； (3) 定义 RAAS/NP 基因中常见遗传变异与生物标志物水平和代谢特征的关系，作为这些途径的病因学重要性的测试（孟德尔随机化）。 FHS 第三代和 Omni 第二代队列提供了大量 (n=4000)、单地点、基于社区的年轻人样本，这些年轻人的 CVD 患病率较低，但肥胖和代谢危险因素的患病率较高。该项目的科学成果将通过其他机制资助的现有代谢和炎症标记数据库、广泛的遗传资源和大型复制队列来提高。有证据表明，肥胖个体的 2 种激素途径（肾素-血管紧张素-醛固酮系统、利尿钠肽系统）活性发生改变，这可能导致他们更容易患上血糖升高、高胆固醇和高血压等疾病。对这些途径的生化标志物的评估可以识别出罹患心血管危险因素的较高风险的肥胖个体，并可以提出新的治疗靶点。

DESCRIPTION (provided by applicant): Obesity accounts for substantial cardiovascular disease (CVD) morbidity and mortality. A fundamental mediator of CVD risk in obesity is the development of insulin resistance and metabolic risk factors (glucose ntolerance, dyslipidemia, and hypertension). However, metabolic risk in obesity is heterogeneous. Activation of the RAAS is a key feature of obesity that may be reversed by weight loss. An activated RAAS triggers the release of NP, which are important counter-regulatory hormones. Unexpectedly, NP levels are depressed ather than elevated in obese individuals, suggesting that obesity is associated with a "natriuretic handicap," The RAAS and NP pathways exert important and opposing influences on glucose metabolism and adipocyte function. Further, pharmacological RAAS blockade is associated with a reduced incidence of diabetes. We hypothesize that the imbalance of renin-angiotensin-aldosterone system (RAAS) activation and natriuretic peptide (NP) downregulation in obese individuals contributes to heterogeneity in metabolic risk. We propose to test our hypothesis by obtaining serial measures of RAAS (plasma renin, angiotensin converting enzyme, aldosterone) and NP (N-terminal pro-B-type natriuretic peptide, N-terminal pro-atrial natriuretic peptide, cGMP) biomarkers, and relating them to longitudinal tracking of metabolic risk factors in a large, community- based cohort (Framingham Heart Study [FHS] 3rd generation and minority Omni 2nd generation participants). Our specific aims are (1) to examine the associations of obesity and longitudinal weight change (over 4 years) with circulating RAAS/NP biomarkers; (2) to relate RAAS/NP biomarkers to the risk of developing metabolic traits; and (3) to define the relations of common genetic variation in RAAS/NP genes with biomarker levels and metabolic traits, as a test of the etiologic importance of these pathways (Mendelian randomization). The FHS 3rd generation and Omni 2nd generation cohorts provide a large (n=4000), single- site, community-based sample of young adults with low CVD prevalence, but a high prevalence of obesity and metabolic risk factors. The scientific yield of the project will be enhanced by existing databases of metabolic and inflammatory markers funded via other mechanisms, extensive genetic resources, and a large replication cohort. Obese individuals have evidence of altered activity in 2 hormonal pathways (renin-angiotensin-aldosterone system, natriuretic peptide system), which may contribute to their susceptibility to developing conditions such as elevated blood sugar, high cholesterol, and hypertension. Assessment ofbiochemial markers of these pathways may identify obese individuals at higher risk of developing cardiovascular risk factors and may suggest novel therapeutic targets.