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Journal of Renin-Angiotensin-Aldosterone System
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Toward a broader understanding of aldosterone in congestive heart failure

Karl T Weber

Division of Cardiovascular Diseases, University of Tennessee, KTWeber@ utmem.edu

Yao Sun

Division of Cardiovascular Diseases, University of Tennessee

Linus A Wodi

Division of Cardiovascular Diseases, University of Tennessee

Ahmad Munir

Division of Cardiovascular Diseases, University of Tennessee

Eiman Jahangir

Division of Cardiovascular Diseases, University of Tennessee

Robert A Ahokas

Department of Obstetrics & Gynecology, University of Tennessee Health Science Center Memphis, TN USA

Ivan C Gerling

Division of Endocrinology, University of Tennessee

Arnold E Postlethwaite

Division of Connective Tissue Diseases, Department of Medicine, University of Tennessee

Kenneth J Warrington

Division of Connective Tissue Diseases, Department of Medicine, University of Tennessee

Discovered some 50 years ago, aldosterone (ALDO) has come to be recognised as a mineralocorticoid hormone with well-known endocrine properties in epithelial cells that contribute to the pathophysiology of congestive heart failure. This includes Na + resorption at the expense of K+ excretion in classic target tissues: kidneys, colon, sweat and salivary glands. Though less well known, Mg2+ excretion is likewise enhanced by ALDO, while adrenal ALDO secretion is regulated by extracellular Mg2+ ([Mg2+ ]o). An emerging body of information has and continues to identify other endocrine actions of ALDO receptor-ligand binding. They include: promoting an efflux of cytosolic free Mg2+, or [Mg2+]i, in exchange for Na+ in such non-epithelial cells as peripheral blood mononuclear cells; its influence on endothelial cell function; and its central actions that involve regulation of cerebrospinal fluid composition produced by epithelial cells of the choroid plexus, activity of the hypothalamic paraventricular nucleus involved in Na+ appetite, Na+ and H2O excretion and sympathetic nerve activity, and the regulation of TNF-{alpha} production from central and/or peripheral sources. Extra-adrenal steroidogenesi and auto/paracrine properties of ALDO generated de novo in the cardiovasculature are now under investigation and preliminary findings suggest they contribute to tissue repair. The past decade has witnessed a revival of interest in this steroid molecule. In years to come, an even broader understanding of ALDO's contribution to the pathophysiology of congestive heart failure will undoubtedly emerge.

Key Words: aldosterone • magnesium • peripheral blood mononuclear cells • oxi/nitrosative stress

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Journal of Renin-Angiotensin-Aldosterone System, Vol. 4, No. 3, 155-163 (2003)
DOI: 10.3317/jraas.2003.024
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