The neuropeptide substance P regulates aldosterone secretion in human adrenals

Julien Wils, Céline Duparc, Anne-Françoise Cailleux, Antoine-Guy Lopez, Caroline Guiheneuf, Isabelle Boutelet, Hadrien-Gaël Boyer, Christophe Dubessy, Saloua Cherifi, Bruno Cauliez, Françoise Gobet, Guillaume Defortescu, Jean-François Ménard, Estelle Louiset and Hervé Lefebvre ()
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Julien Wils: Normandie Univ, UNIROUEN, INSERM, DC2N
Céline Duparc: Normandie Univ, UNIROUEN, INSERM, DC2N
Anne-Françoise Cailleux: Rouen University Hospital, Department of Endocrinology, Diabetes and Metabolic Diseases
Antoine-Guy Lopez: Normandie Univ, UNIROUEN, INSERM, DC2N
Caroline Guiheneuf: Rouen University Hospital, Department of Endocrinology, Diabetes and Metabolic Diseases
Isabelle Boutelet: Normandie Univ, UNIROUEN, INSERM, DC2N
Hadrien-Gaël Boyer: Normandie Univ, UNIROUEN, INSERM, DC2N
Christophe Dubessy: Normandie Univ, UNIROUEN, INSERM, DC2N
Saloua Cherifi: Normandie Univ, UNIROUEN, INSERM, DC2N
Bruno Cauliez: Rouen University Hospital, Department of Biochemistry
Françoise Gobet: Rouen University Hospital, Department of Pathology
Guillaume Defortescu: Rouen University Hospital, Department of Urology
Jean-François Ménard: Rouen University Hospital, Department of Biostatistics
Estelle Louiset: Normandie Univ, UNIROUEN, INSERM, DC2N
Hervé Lefebvre: Normandie Univ, UNIROUEN, INSERM, DC2N

Nature Communications, 2020, vol. 11, issue 1, 1-11

Abstract: Abstract Aldosterone, produced by the adrenals and under the control of plasma angiotensin and potassium levels, regulates hydromineral homeostasis and blood pressure. Here we report that the neuropeptide substance P (SP) released by intraadrenal nerve fibres, stimulates aldosterone secretion via binding to neurokinin type 1 receptors (NK1R) expressed by aldosterone-producing adrenocortical cells. The action of SP is mediated by the extracellular signal-regulated kinase pathway and involves upregulation of steroidogenic enzymes. We also conducted a prospective proof-of-concept, double blind, placebo-controlled clinical trial aimed to investigate the impact of the NK1R antagonist aprepitant on aldosterone secretion in healthy male volunteers (EudraCT: 2008-003367-40, ClinicalTrial.gov: NCT00977223). Participants received during two 7-day treatment periods aprepitant (125 mg on the 1st day and 80 mg during the following days) or placebo in a random order at a 2-week interval. The primary endpoint was plasma aldosterone levels during posture test. Secondary endpoints included basal aldosterone alterations, plasma aldosterone variation during metoclopramide and hypoglycaemia tests, and basal and stimulated alterations of renin, cortisol and ACTH during the three different stimulatory tests. The safety of the treatment was assessed on the basis of serum transaminase measurements on days 4 and 7. All pre-specified endpoints were achieved. Aprepitant decreases aldosterone production by around 30% but does not influence the aldosterone response to upright posture. These results indicate that the autonomic nervous system exerts a direct stimulatory tone on mineralocorticoid synthesis through SP, and thus plays a role in the maintenance of hydromineral homeostasis. This regulatory mechanism may be involved in aldosterone excess syndromes.

Date: 2020
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DOI: 10.1038/s41467-020-16470-8

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