NDT Advance Access originally published online on May 5, 2004
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Nephrol Dial Transplant (2004) 19: 1716-1723
Nephrol Dial Transplant Vol. 19 No. 7 © ERA-EDTA 2004; all rights reserved
Original Article
Antifibrotic, nephroprotective potential of ACE inhibitor vs AT1 antagonist in a murine model of renal fibrosis
1 Medical Faculty University of Cologne, Department of Internal Medicine I, Cologne General Hospital, Merheim Medical Center, Cologne, Germany, 2 Department of Anatomy I, and 3 Center for Biochemistry, The Medical Faculty, University of Cologne, Cologne, Germany
Correspondence and offprint requests to: Dr O. Gross, Department of Internal Medicine I, Merheim Medical Center, Cologne General Hospital, Ostmerheimer Straße 200, D-51109 Cologne, Germany. Email: oliver.gross{at}uni-koeln.de
Background. Several studies have shown antifibrotic effects of angiotensin converting enzyme (ACE) inhibitors as well as of angiotensin receptor 1 (AT1) antagonists, however, prospective trials with clinical end points comparing these effects do not exist. COL4A3–/– mice develop a non-hypertensive progressive renal fibrosis. We used this animal model to compare the potential of ACE inhibitor vs AT1 antagonist to prevent renal fibrosis irrespective of blood pressure-dependent involvement by the renin system.
Methods. COL4A3–/– mice were treated with placebo, ramipril or candesartan. Blood pressure, proteinuria, serum urea and lifespan were monitored. Renal matrix was characterized by immuno-histochemistry, light and electron microscopy. Further biochemical analysis was provided using cDNA microarray and western blot techniques.
Results. Untreated mice died of renal failure after 71±6 days. Ramipril and candesartan both delayed onset and reduced the extent of proteinuria. Both had minor effects on blood pressure and postponed onset of uraemia. Ramipril increased lifespan by 111% to 150±21 days (P<0.01), whereas candesartan resulted in only a 38% prolongation to 98±16 days (P<0.01). Ramipril reduced glomerular and tubulo-interstitial fibrosis and numbers of activated fibroblasts to a greater extent than candesartan. Microarray and western blot analysis revealed a higher antifibrotic potential of ramipril in terms of downregulation of TGFß, connective tissue growth factor, metalloproteinases and extracellular matrix proteins.
Conclusions. The results indicate an antifibrotic, nephroprotective effect of ACE inhibitors and AT1 antagonists in an animal model of progressive renal fibrosis. The greater antifibrotic effect of ramipril at the maximal therapeutic doses employed may not be explained by different antiproteinuric or blood pressure lowering properties, but by—in contrast to candesartan—its ability to hinder the proinflammatory, profibrotic activation of the angiotensin receptor 2.
Keywords: angiotensin; collagen; fibrinogen; renal hypertension; renal hypertension
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