Novel diuretic targets

Am J Physiol Renal Physiol. 2013 Oct 1;305(7):F931-42. doi: 10.1152/ajprenal.00230.2013. Epub 2013 Jul 17.

Abstract

As the molecular revolution continues to inform a deeper understanding of disease mechanisms and pathways, there exist unprecedented opportunities for translating discoveries at the bench into novel therapies for improving human health. Despite the availability of several different classes of antihypertensive medications, only about half of the 67 million Americans with hypertension manage their blood pressure appropriately. A broader selection of structurally diverse antihypertensive drugs acting through different mechanisms would provide clinicians with greater flexibility in developing effective treatment regimens for an increasingly diverse and aging patient population. An emerging body of physiological, genetic, and pharmacological evidence has implicated several renal ion-transport proteins, or regulators thereof, as novel, yet clinically unexploited, diuretic targets. These include the renal outer medullary potassium channel, ROMK (Kir1.1), Kir4.1/5.1 potassium channels, ClC-Ka/b chloride channels, UTA/B urea transporters, the chloride/bicarbonate exchanger pendrin, and the STE20/SPS1-related proline/alanine-rich kinase (SPAK). The molecular pharmacology of these putative targets is poorly developed or lacking altogether; however, recent efforts by a few academic and pharmaceutical laboratories have begun to lessen this critical barrier. Here, we review the evidence in support of the aforementioned proteins as novel diuretic targets and highlight examples where progress toward developing small-molecule pharmacology has been made.

Keywords: ClC-K; Kir4.1/5.1; ROMK; pendrin; urea transporter.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Chloride Channels / metabolism
  • Diuretics / pharmacology*
  • Diuretics / therapeutic use
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / metabolism
  • Membrane Transport Proteins / metabolism
  • Molecular Targeted Therapy*
  • Potassium Channels, Inwardly Rectifying / metabolism*
  • Protein Serine-Threonine Kinases / metabolism
  • Sulfate Transporters

Substances

  • Chloride Channels
  • Diuretics
  • Membrane Transport Proteins
  • Potassium Channels, Inwardly Rectifying
  • SLC26A4 protein, human
  • Sulfate Transporters
  • urea transporter
  • Protein Serine-Threonine Kinases
  • STK39 protein, human