肾素-血管紧张素系统与糖尿病心肌病关系的研究进展

糖尿病时,肾素-血管紧张素系统(renin-angiotensin system,RAS)被激活,升高的血管紧张素Ⅱ(Ang Ⅱ)通过细胞表面的AT1受体,刺激心肌成纤维细胞增生及胶原代谢改变,引起心脏结构重塑,导致心肌间质及血管周围纤维化,胶原含量增多和排列紊乱,造成心室肌僵硬而影响舒张功能,出现糖尿病心肌病(diabetic cardiomyopathy,DCM)的临床症状.本文从RAS的主要成分Ang Ⅱ、Ang-(1-7)、Ac-SDKP和血管紧张素受体(ATR)与内皮素、活性氧、转化生长因子-β1、核因子-κB、信号转导系统以及细胞凋亡之间的相互作用,阐述RAS在糖尿病心肌病发生发展中所起的重要作用.     

血清AngⅡ、Ang-(1-7)表达水平与多囊卵巢综合征患者卵巢间质血流的关系

摘要 目的：探究血清肾素-血管紧张素系统（RAS）相关因子[血管紧张素（Ang）Ⅱ、Ang-(1-7)]表达水平与多囊卵巢综合征(PCOS)患者卵巢间质血流的关系。方法：选取2020年7月至2021年10月于我院诊治的PCOS患者88例,按照胰岛素抵抗指数(HOMA-IR)将入选者分为两组,其中HOMA-IR≥2.69者分为胰岛素抵抗组(PCOS-IR组,n=42),HOMA-IR＜2.69者分为非胰岛素抵抗组(PCOS-NIR组,n=46)。此外,选取同期于我院进行体检的健康女性志愿者90例为对照组。采用酶联免疫吸附法(ELISA)测定血清中的AngⅡ、Ang-(1-7)表达水平,同时采用EPIQ5型彩色多普勒超声仪对所有受试者在采血当天进行卵巢间质血流监测,并计算峰值血流速度（PSV）、搏动指数(PI)和阻力指数(RI)。采用Pearson检验分析PCOS患者AngⅡ、Ang-(1-7)与卵巢间质血流指标的相关性。应用多因素Logistic回归分析PCOS患者卵巢间质血流的影响因素。结果：相较于对照组,PCOS组AngⅡ、Ang-(1-7)、PSV、HOMA-IR水平明显更高,而PI、RI水平则明显更低(P<0.05);相较于PCOS-NIR组,PCOS-IR组AngⅡ、Ang-(1-7)、PSV、HOMA-IR水平明显更高,而PI、RI水平则明显更低(P<0.05);Pearson相关分析结果显示,AngⅡ、Ang-(1-7)与PSV、HOMA-IR均呈正相关(P<0.05),而与PI、RI均呈负相关(P<0.05);同时AngⅡ、Ang-(1-7)呈正相关(P<0.05)。经多因素Logistic回归分析显示,AngⅡ、Ang-(1-7)、HOMA-IR是PCOS患者卵巢间质血流的相关影响因素(P<0.05)。结论：AngⅡ、Ang-(1-7)在PCOS患者血清中呈高表达,二者之间呈正相关,且在伴有胰岛素抵抗的PCOS患者血清中表达水平进一步升高,两者表达失衡在PCOS患者卵巢间质血流异常增多中起重要作用。     

血管紧张素Ⅱ对单核/巨噬细胞的致炎作用及其药物干预

动脉粥样硬化斑块形成和破裂的重要原因是病变部位炎症反应的加剧,而巨噬细胞作为粥样斑块内主要的炎症细胞,在炎症反应中起主导作用.血管紧张素Ⅱ作为一种重要促炎因子,促进单核/巨噬细胞浸润于动脉粥样硬化斑块,激活斑块内的巨噬细胞,上调各种炎症因子,从而参与动脉粥样硬化的发生发展过程.血管紧张素转化酶抑制剂、AngⅡ受体阻断剂、调血脂药、干扰素-β、雌激素等药物可减轻血管紧张素Ⅱ诱导的血管壁炎症反应,发挥抗动脉粥样硬化作用.     

肾脏中肾素-血管紧张素系统的生理和病理生理作用

肾脏中肾素-血管紧张素系统(RAS)在肾脏生理功能的调节中有重要作用.近年来,肾脏RAS的新成分及新作用机制不断被发现.转基因动物研究使肾脏血管紧张素Ⅱ(AngⅡ)在血压及水钠平衡调节中的作用进一步阐明;AngⅡ的非血流动力学作用已经确立;血管紧张素转换酶2(ACE2)及Ang 1～7对肾功能的调节作用也已得到认可.肾素/前肾素特异性受体、ACE的信号转导功能,以及AT1受体的转激活功能等,已成为肾脏生理科学研究的热点.这些研究对于人们认识肾脏局部RAS功能,探讨延缓慢性肾脏病的进展的治疗策略具有重要意义.     

血管紧张素—（1—7）对大鼠血管平滑肌细胞PKC和ERK1／2的抑制作用

采用Western blot,氘－胸腺嘧啶（3H－TdR)和氘－亮氨酸（3H－Leu)掺入等技术和方法,用血管紧张素Ⅱ（AngⅡ)和血管紧张素－（1－7）[Ang-(1-7)]刺激大鼠血管平滑肌细胞（VSMCs),观察和分析Ang-(1-7)对VSMCs增殖及蛋白激酶C（PKC）和胞外调节蛋白激酶（ERK）表达的影响,Ang-(1-7)能明显抑制基础和AngⅡ刺激下的VSMCs PKC-Ⅱ和ERK1／2蛋白表达（P＜0．01或P＜0．05）,减少3H－TdR和3H－Leu掺入量（P＜0．01或P＜0．05）,结果提示,Ang-(1-7)对VSMCs增殖有抑制作用,这可能与影响PKC－ζ和ERK1／2蛋白表达有关。     

ACE2及其特殊功能

血管紧张素转换酶2（angiotensin—converting enzyme 2,ACE2）是新发现的与血管紧张素转换酶（ACE）相关的羧肽酶,在肾素-血管紧张素系统（rennin-angiotensin system,RAS）中ACE2可以使AngⅡ转换为Ang1-7,从而产生与血管紧张素Ⅱ相反的效应,同时ACE2还可使Ang I转换为Ang1-9。研究发现：ACE2与高血压、SARS以及肾脏、生殖等系统的疾病有着密切的关系。     

血管紧张素转换酶2-血管紧张素1-7-Mas轴对血管作用的研究进展

血管紧张素转换酶2（ACE2）和Mas受体的发现使人们对肾素-血管紧张素（RAS）有了更全面的认识。ACE2可水解血管紧张素Ⅰ和血管紧张素Ⅱ直接或间接生成血管紧张素1-7（Ang 1-7）,并与高血压的形成密切相关。Ang 1-7主要通过Mas受体引起血管舒张、抑制细胞增殖。ACE2-Ang1-7-Mas轴的发现为RAS的研究、高血压等心血管疾病的防治和新药开发提供了新的思路和方向。     

肾素-血管紧张素系统的新调节分子:ACE2

血管紧张素转化酶（angiotensin—converting enzyme,ACE）为含锌的金属蛋白酶,是肾素-血管紧张素系统（renin—angiotensin system,RAS）重要的调节分子。血管紧张素转化酶2（angiotensin—con—verting enzyme2,ACE2）是迄今发现的唯一的ACE同系物（homologue）,它主要分布于睾丸、肾脏和心脏。ACE2可水解血管紧张素Ⅰ（angiotensinⅠ,AngⅠ）和血管紧张素Ⅱ（angiotensinⅡ,AngⅡ）羧基端的1个氨基酸残基,分别形成Ang1-9和有血管舒张作用的Ang1-7。ACE2的生理病理作用还不甚明了,传统的ACE抑制剂不能抑制ACE2的活性。ACE2在心血管、肾脏系统的作用可能与ACE相反．与ACE共同调节心脏、肾脏等脏器的正常功能。     

血管紧张素-(1-7)对大鼠血管平滑肌细胞PKC和ERK1/2的抑制作用

采用Westernblot、氚 胸腺嘧啶 ( 3H TdR)和氚 亮氨酸 ( 3H Leu )掺入等技术和方法 ,用血管紧张素Ⅱ(AngⅡ )和血管紧张素 ( 1 7) [Ang ( 1 7) ]刺激大鼠血管平滑肌细胞 (VSMCs) ,观察和分析Ang ( 1 7)对VSMCs增殖及蛋白激酶C (PKC)和胞外调节蛋白激酶 (ERK)表达的影响。Ang ( 1 7)能明显抑制基础和AngⅡ刺激下的VSMCsPKC ζ和ERK1/ 2蛋白表达 (P <0 0 1或P <0 0 5 ) ,减少3H TdR和3H Leu掺入量 (P <0 0 1或P <0 0 5 )。结果提示 ,Ang ( 1 7)对VSMCs增殖有抑制作用 ,这可能与影响PKC ζ和ERK1/ 2蛋白表达有关。     

血管紧张素-(1-7)的舒血管效应

实验采用兔外周动脉离体标本,在预收缩血管后,用血管紧张素[angiotensin-(1-7),Ang-(1-7)]舒张血管,比较Ang-(1-7)对外周各血管床的舒张效应并分析其产生机制。结果显示：(1)Ang-(1-7)可剂量依赖性舒张血管,但舒张作用有所不同;(2)Ang-(1-7)的舒张作用在很大程度上依赖于内皮的NO系统;(3)Ang-(1-7)的舒张血管效应不通过AT1和AT2受体。上述结果提示：Ang-(1-7)可能作用于内皮上的非AT1和AT2受体,通过调节NO释放而起舒血管作用。     

Different Effects of Angiotensin II and Angiotensin-(1-7) on Vascular Smooth Muscle Cell Proliferation and Migration

Background

Angiotensin (Ang) II and Ang-(1-7) are two of the bioactive peptides of the rennin-angiotensin system. Ang II is involved in the development of cardiovascular disease, such as hypertension and atherosclerosis, while Ang-(1-7) shows cardiovascular protection in contrast to Ang II.

Methodology/Principal Findings

In this study, we investigated effects of Ang II and Ang-(1-7) on vascular smooth muscle cell (SMC) proliferation and migration, which are critical in the formation of atherosclerotic lesions. Treatment with Ang II resulted in an increase of SMC proliferation, whereas Ang-(1-7) alone had no effects. However, preincubation with Ang-(1-7) inhibited Ang II-induced SMC proliferation. Ang II promoted SMC migration, and this effect was abolished by pretreatment with Ang-(1-7). The stimulatory effects of Ang II on SMC proliferation and migration were blocked by the Ang II receptor antagonist lorsartan, while the inhibitory effects of Ang-(1-7) were abolished by the Ang-(1-7) receptor antagonist A-799. Ang II treatment caused activation of ERK1/2 mediated signaling, and this was inhibited by preincubation of SMCs with Ang-(1-7).

Conclusion

These results suggest that Ang-(1-7) inhibits Ang II-induced SMC proliferation and migration, at least in part, through negative modulation of Ang II induced ERK1/2 activity.     

Angiotensin-(1-7) abrogates mitogen-stimulated proliferation of cardiac fibroblasts

Previous studies showed that angiotensin-(1-7) [Ang-(1-7)] attenuates cardiac remodeling by reducing both interstitial and perivascular fibrosis. Although a high affinity binding site for Ang-(1-7) was identified on cardiac fibroblasts, the molecular mechanisms activated by the heptapeptide hormone were not identified. We isolated cardiac fibroblasts from neonatal rat hearts to investigate signaling pathways activated by Ang-(1-7) that participate in fibroblast proliferation. Ang-(1-7) reduced (3)H-thymidine, -leucine and -proline incorporation into cardiac fibroblasts stimulated with serum or the mitogen endothelin-1 (ET-1), demonstrating that the heptapeptide hormone decreases DNA, protein and collagen synthesis. The reduction in DNA synthesis by Ang-(1-7) was blocked by the AT((1-7)) receptor antagonist [d-Ala(7)]-Ang-(1-7), showing specificity of the response. Treatment of cardiac fibroblasts with Ang-(1-7) reduced the Ang II- or ET-1-stimulated increase in phospho-ERK1 and -ERK2. In contrast, Ang-(1-7) increased dual-specificity phosphatase DUSP1 immunoreactivity and mRNA, suggesting that the heptapeptide hormone increases DUSP1 to reduce MAP kinase phosphorylation and activity. Incubation of cardiac fibroblasts with ET-1 increased cyclooxygenase 2 (COX-2) and prostaglandin synthase (PGES) mRNAs, while Ang-(1-7) blocked the increase in both enzymes, suggesting that the heptapeptide hormone alters the concentration and the balance between the proliferative and anti-proliferative prostaglandins. Collectively, these results indicate that Ang-(1-7) participates in maintaining cardiac homeostasis by reducing proliferation and collagen production by cardiac fibroblasts in association with up-regulation of DUSP1 to reduce MAP kinase activities and attenuation of the synthesis of mitogenic prostaglandins. Increased Ang-(1-7) or agents that enhance production of the heptapeptide hormone may prevent abnormal fibrosis that occurs during cardiac pathologies.     

Lack of Renoprotective Effect of Chronic Intravenous Angiotensin-(1-7) or Angiotensin-(2-10) in a Rat Model of Focal Segmental Glomerulosclerosis

Unopposed angiotensin (Ang) II-mediated cellular effects may lead to progressive glomerulosclerosis. While Ang-II can be locally generated in the kidneys, we previously showed that glomerular podocytes primarily convert Ang-I, the precursor of Ang-II, to Ang-(1-7) and Ang-(2-10), peptides that have been independently implicated in biological actions opposing those of Ang-II. Therefore, we hypothesized that Ang-(1-7) and Ang-(2-10) could be renoprotective in the fawn-hooded hypertensive rat, a model of focal segmental glomerulosclerosis. We evaluated the ability of 8–12 week-long intravenous administration of either Ang-(1-7) or Ang-(2-10) (100–400 ng/kg/min) to reduce glomerular injury in uni-nephrectomized fawn-hooded hypertensive rats, early or late in the disease. Vehicle-treated rats developed hypertension and lesions of focal segmental glomerulosclerosis. No reduction in glomerular damage was observed, as measured by either 24-hour urinary protein excretion or histological examination of glomerulosclerosis, upon Ang-(1-7) or Ang-(2-10) administration, regardless of peptide dose or disease stage. On the contrary, when given at 400 ng/kg/min, both peptides induced a further increase in systolic blood pressure. Content of Ang peptides was measured by parallel reaction monitoring in kidneys harvested at sacrifice. Exogenous administration of Ang-(1-7) and Ang-(2-10) did not lead to a significant increase in their corresponding intrarenal levels. However, the relative abundance of Ang-(1-7) with respect to Ang-II was increased in kidney homogenates of Ang-(1-7)-treated rats. We conclude that chronic intravenous administration of Ang-(1-7) or Ang-(2-10) does not ameliorate glomerular damage in a rat model of focal segmental glomerulosclerosis and may induce a further rise in blood pressure, potentially aggravating glomerular injury.     

Potentiation of the hypotensive effect of bradykinin by angiotensin-(1-7)-related peptides.

In this study, we evaluated the bradykinin potentiating activity and ACE inhibitory activity of several Ang-(1-7)-related peptides: Ang-(2-7), Ang-(3-7), Ang-(4-7), Ang-(1-6), Ang-(1-5) and the selective antagonist of Ang-(1-7): D-[Ala7]Ang-(1-7) (A-779). In vivo experiments were performed in freely moving Wistar rats. ACE activity was evaluated by a fluorometric assay in rat plasma using Hip-His-Leu as a substrate. Intravenous injections of Ang-(1-7) (2.2 nmol) transformed the effect of a single dose of bradykinin (1 nmol) into the effect produced by a double dose. A similar bradykinin potentiating activity was demonstrated for Ang-(2-7) and Ang-(3-7). On the other hand, Ang-(1-5), Ang-(1-6), Ang-(4-7) and A-779 did not change the hypotensive effect of bradykinin in doses ranging from 8 up to 25 nmols. The hypotensive effect of bradykinin was increased by intravenous infusion (0.3 ng/min) of Ang-(1-7) > Ang-(2-7) > Ang-(3-7). Conversely, Ang-(1-5), Ang-(1-6), Ang-(4-7) or A-779 did not change the hypotensive effect of bradykinin. ACE inhibition with Ang-(1-7) related peptides occurred in the order: Ang-(2-7) > or = Ang-(3-7) > Ang-(1-7) [>] Ang-(1-5) > Ang-(4-7) > or = Ang-(1-6) > or = A-779. A-779 in concentrations up to 10(-5) M did not change the ACE inhibitory activity of Ang-(1-7). These results suggest that Ang-(1-7), Ang-(2-7) and Ang-(3-7) can modulate bradykinin actions in vivo. More important, our data pointed out that alternative mechanisms besides interaction with ACE are required to explain the bradykinin potentiating activity of Ang-(1-7).     

Evidence for a new angiotensin-(1-7) receptor subtype in the aorta of Sprague-Dawley rats

We have recently described, in the mouse aorta, the vasodilator effect of angiotensin-(1-7) (Ang-(1-7)) was mediated by activation of the Mas Ang-(1-7) receptor and that A-779 and D-Pro7-Ang-(1-7) act as Mas receptor antagonists. In this work we show pharmacological evidence for the existence of a different Ang-(1-7) receptor subtype mediating the vasodilator effect of Ang-(1-7) in the aorta from Sprague-Dawley (SD) rats. Ang-(1-7) induced an endothelium-dependent vasodilator effect in aortic rings from SD rats which was inhibited by removal of the endothelium and by L-NAME (100 microM) but not by indomethacin (10 microM). The Ang-(1-7) receptor antagonist D-Pro7-Ang-(1-7) (0.1 microM) abolished the vasodilator effect of the peptide. However, the other specific Ang-(1-7) receptor antagonist, A-779 in concentrations up to 10 microM, did not affect vasodilation induced by Ang-(1-7). The Ang II AT1 and AT2 receptors antagonists CV11974 (0.01 microM) and PD123319 (1 microM), respectively, the bradykinin B2 receptor antagonist HOE 140 (1 microM) and the inhibitor of ACE captopril (10 microM) did not change the effect of Ang-(1-7). Our results show that in the aorta of SD rats, the vasodilator effect of Ang-(1-7) is dependent on endothelium-derived nitric oxide. This effect is mediated by the activation of Ang-(1-7) receptors sensitive to D-Pro7-Ang-(1-7), but not to A-779, which suggests the existence of a different Ang-(1-7) receptor subtype.     

Characterization of angiotensin-(1-7) receptor subtype in mesenteric arteries

Mesenteric arteries from male Sprague-Dawley rats were mounted in a pressurized myograph system. Ang-(1-7) concentration-dependent responses were determined in arteries preconstricted with endothelin-1 (10(-7)M). The receptor(s) mediating the Ang-(1-7) evoked dilation were investigated by pretreating the mesenteric arteries with specific antagonists of Ang-(1-7), AT(1) or AT(2) receptors. The effects of Ang-(3-8) and Ang-(3-7) were also determined. Ang-(1-7) caused a concentration-dependent dilation (EC(50): 0.95 nM) that was blocked by the selective Ang-(1-7) receptor antagonist D-[Ala(7)]-Ang-(1-7). Administration of a specific antagonist to the AT(2) receptor (PD123319) had no effect. On the other hand, losartan and CV-11974 attenuated the Ang-(1-7) effect. These results demonstrate that Ang-(1-7) elicits potent dilation of mesenteric resistance vessels mediated by a D-[Ala(7)]-Ang-(1-7) sensitive site that is also sensitive to losartan and CV-11974.     

Effect and mechanism of the Ang-(1-7) on human mesangial cells injury induced by low density lipoprotein

Hyperlipidemia is an independent risk factor for renal disease, and lipid deposition is associated with glomerulosclerosis. The angiotensin converting enzyme 2-angiotensin-(1-7)-Mas axis (ACE2-Ang-(1-7)-Mas axis) has been reported to participate in lipid metabolic regulation but its mechanism remains unclear. We hypothesized Ang-(1-7) would reduce lipid uptake in human mesangial cells (HMCs) by regulating the low density lipoprotein receptor–sterol regulatory element binding proteins 2–SREBP cleavage activating protein (LDLr–SREBP2–SCAP) negative feedback system, and improve glomerulosclerosis by regulating the transforming growth factor-β1 (TGF-β1). In this study we found that ACE2 was undetected in HMCs. The administration of LDL caused normal LDLr–SREBPs–SCAP negative feedback effect. Exogenous Ang-(1-7) enhanced this negative feedback effect via down-regulating LDLr, SREBP2, and SCAP expression, and effectively inhibited LDL-induced lipid deposition and cholesterol increases. This enhanced inhibitory effect was reversed by the Mas receptor antagonist A-779. Meanwhile, Ang-(1-7) significantly decreased the high LDL-induced production of TGF-β1, an effect blocked by A-779. Interestingly, HMCs treated with Ang-(1-7) alone activated the TGF-β1 expression. Our results suggested that Ang-(1-7) inhibits LDL accumulation and decreases cholesterol levels via modulating the LDLr–SREBPs–SCAP negative feedback system through the Mas receptor. Moreover, Ang-(1-7) exhibits a dual regulatory effect on TGF-β1 in HMCs.     

Synergistic effect of angiotensin-(1-7) on bradykinin arteriolar dilation in vivo

The interaction between angiotensin [Ang-(1-7)] and bradykinin (BK) was determined in the mesentery of anesthetized Wistar rats using intravital microscopy. Topical application of BK and Ang-(1-7) induced vasodilation that was abolished by the BK B2 receptor antagonist HOE-140 and the Ang-(1-7) antagonist A-779, respectively. BK (1 pmol)-induced vasodilation, but not SNP and ACh responses, was potentiated by Ang-(1-7) 10 pmol and 100 pmols. The effect of 100 pmol of Ang-(1-7) on BK-induced vasodilation was abolished by A-779, indomethacin, and L-nitroarginine methyl esther, whereas losartan was without effect. Enalaprilat treatment enhanced the BK- and Ang-(1-7)-induced vasodilation and the potentiating effect of Ang-(1-7) on BK vasodilation. The potentiation of BK-induced vasodilation by Ang-(1-7) is a receptor-mediated phenomenon dependent on cyclooxygenase-related products and NO release.