Combination renin-angiotensin system blockade and angiotensin-converting enzyme 2 in experimental myocardial infarction: Implications for future therapeutic directions

Luke J. Burchill, Elena Velkoska, Rachael G. Dean, Karen Griggs, Sheila K. Patel, Louise M. Burrell

    Research output: Contribution to journalArticle

    46 Scopus citations

    Abstract

    The RAS (renin-angiotensin system) is activated after MI (myocardial infarction), and RAS blockade with ACEis [ACE (angiotensin-converting enzyme) inhibitors] or ARBs (angiotensin receptor blockers) slows but does not completely prevent progression to heart failure. Cardiac ACE is increased after MI and leads to the formation of the vasoconstrictor AngII (angiotensin II). The enzyme ACE2 is also activated after MI and degrades AngII to generate the vasodilator Ang-(1-7) [angiotensin-(1-7)]. Overexpression of ACE2 offers cardioprotective effects in experimental MI, but there is conflicting evidence as to whether the benefits of ACEis and ARBs are mediated through increasing ACE2 after MI. In the present study, we assessed the effect of an ACEi and ARB, alone and in combination, on cardiac ACE2 in a rat MI model. MI rats received vehicle, ACEi (ramipril; 1 mg/kg of body weight), ARB (valsartan; 10 mg/kg of body weight) or combination (ramipril at 1 mg/kg of body weight and valsartan at 10 mg/kg of body weight) orally for 28 days. Sham-operated rats were also studied and received vehicle alone. MI increased LV (left ventricular) mass (P < 0.0001), impaired cardiac contractility (P < 0.05) and activated cardiac ACE2 with increased gene (P < 0.05) and protein expression (viable myocardium, P < 0.05; border zone, P < 0.001; infarct, P < 0.05). Ramipril and valsartan improved remodelling (P < 0.05), with no additional effect of dual therapy. Although ramipril inhibited ACE, and valsartan blocked the angiotensin receptor, neither treatment alone nor in combination augmented cardiac ACE2 expression. These results suggest that the cardioprotective effects of ramipril and valsartan are not mediated through up-regulation of cardiac ACE2. Strategies that do augment ACE2 after MI may be a useful addition to standard RAS blockade after MI.

    Original languageEnglish (US)
    Pages (from-to)649-658
    Number of pages10
    JournalClinical science
    Volume123
    Issue number11
    DOIs
    StatePublished - Dec 1 2012

    Keywords

    • Angiotensin receptor blocker
    • Angiotensin-converting enzyme
    • Angiotensin-converting enzyme inhibitor
    • Myocardial infarction
    • Renin-angiotensin system

    ASJC Scopus subject areas

    • Medicine(all)

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