臨牀透析 Vol.14 No.4(2-8)


特集名 Uremic Toxins
題名 各論 (8) グアニジノ化合物
発刊年月 1998年 04月
著者 青柳 一正 筑波大学臨床医学系内科学
【 要旨 】 グアニジノコハク酸(GSA)やメチルグアニジン(MG)は腎不全で産生が増加する.新しいGSAの作用としてNO同様のcGMPの増加を伴う血管拡張作用とNMDA受容体の活性化による痙攣誘発,MGにはiNOSの阻害作用と血圧上昇作用が判明してきた.筆者らは,(1) GSAが活性酸素やNOとアルギニン前駆体アルギニノコハク酸から産生されることを解明した.(2) MGはクレアチニンとハイドロキシルラジカルが反応した中間体(後にクレアトールと同定された)を経て産生されることを報告した.また,(3) MG産生を活性酸素産生の指標とし,ピューロマイシン・アミノヌクレオサイド(PAN)がMG産生を増加させ,(4) その増加はカルシウム依存性蛋白リン酸化酵素(PKC)の阻害剤で阻止され,(5) PANがラット腎のPKCを迅速に活性化させることを報告した.強い副甲状腺機能亢進症でMG産生亢進が報告され,PKCとの関連が示唆される.
Theme Uremic Toxins
Title Mechanism of increased synthesis of guanidinocompounds in renal failure and their new actions
Author Kazumasa Aoyagi Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba
[ Summary ] The increased synthesis of guanidinosuccinate (GSA) and methylguanidine (MG) known as uremic toxin has been noted. Recently, vasodilation with the increase of cGMP and activation of NMDA receptor by GSA and the inhibition of iNOS by MG were reported as new actions of these compounds.
We clarified the following. 1) GSA is formed from reactive oxygen and argininosuccinate which might be increased by the addition of urea. 2) MG is formed via an intermediate (identified as creatol) Iater, that is, it is formed from a hydroxyl radical and creatinine. 3) Puromycin aminonucleoside (PAN) increased MG synthesis. 4) This increase of MG synthesis is inhibited by a protein kinase C (PKC)inhibitor. 5) PAN rapidly activated PKC in rat kidney tissue. These results suggested that hydroxyl radical generation in tissue cells may be increased by PKC activation. PKC activation is expected in those patients with severe hyperparathyroidism whose MG synthesis has increased.
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