Abstract-The aim of this study was to explore the effects of the renin inhibitor aliskiren in streptozotocin-diabetic TG(mRen-2)27 rats. Furthermore, we investigated in vitro the effect of aliskiren on the interactions between renin and the (pro)renin receptor and between aliskiren and prorenin. Aliskiren distributed extensively to the kidneys of normotensive (non)diabetic rats, localizing in the glomeruli and vessel walls after 2 hours exposure. In diabetic TG(mRen-2)27 rats, aliskiren (10 or 30 mg/kg per day, 10 weeks) lowered blood pressure, prevented albuminuria, and suppressed renal transforming growth factor-␤ and collagen I expression versus vehicle. Aliskiren reduced (pro)renin receptor expression in glomeruli, tubules, and cortical vessels compared to vehicle (in situ hybridization). In human mesangial cells, aliskiren (0.1 mol/L to 10 mol/L) did not inhibit binding of 125 I-renin to the (pro)renin receptor, nor did it alter the activation of extracellular signal-regulated kinase 1/2 by renin (20 nmol/L) preincubated with aliskiren (100 nmol/L) or affect gene expression of the (pro)renin receptor. Evidence was obtained that aliskiren binds to the active site of prorenin. The above results demonstrate the antihypertensive and renoprotective effects of aliskiren in experimental diabetic nephropathy. The evidence that aliskiren can reduce in vivo gene expression for the (pro)renin receptor and that it may block prorenin-induced angiotensin generation supports the need for additional work to reveal the mechanism of the observed renoprotection by this renin inhibitor. Key Words: aliskiren Ⅲ renin inhibitor Ⅲ TG(mRen-2)rat Ⅲ diabetic nephropathy Ⅲ (pro)renin receptor A central role for the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of diabetic nephropathy (DN) is widely accepted, based largely on the attenuation of DN by angiotensin (Ang) converting enzyme inhibitors (ACEi) 1 and Ang II receptor blockers (ARB). 2 However, these agents do not halt renal decline, possibly because of insufficient suppression of the intrarenal RAAS. Theoretically, agents that more effectively suppress the RAAS should confer improved tissue protection over current treatments for DN. Renin inhibitors, by acting at the point of activation of the RAAS cascade, may represent such agents. Aliskiren is a potent inhibitor of human renin; it lowers blood pressure (BP) in patients with mild-moderate hypertension 3,4 and shows cardiorenal protection in hypertensive double transgenic rats expressing human genes for renin and angiotensinogen. 5

Aside from a well-documented induction of angiotensinogen, ERT is related to a substantial suppression of renin, a phenomenon that might have received little attention because of widely used indirect measurements of the hormone.

Abstract-The recently cloned (pro)renin receptor [(P)RR] mediates renin-stimulated cellular effects by activating mitogen-activated protein kinases and promotes nonproteolytic prorenin activation. In vivo, (P)RR is said to be blocked with a peptide consisting of 10 amino acids from the prorenin prosegment called the "handle-region" peptide (HRP). We tested whether human prorenin and renin induce extracellular signal-regulated kinase (ERK) 1/2 activation and whether the direct renin inhibitor aliskiren or the HRP inhibits the receptor. We detected the (P)RR mRNA and protein in isolated human monocytes and in U937 monocytes. In U937 cells, we found that both human renin and prorenin induced a long-lasting ERK 1/2 phosphorylation despite angiotensin II type 1 and 2 receptor blockade. In contrast to angiotensin II-ERK signaling, renin and prorenin signaling did not involve the epidermal growth factor receptor. A mitogen-activated protein kinase kinase 1/2 inhibitor inhibited both renin and prorenin-induced ERK 1/2 phosphorylation. Neither aliskiren nor HRP inhibited binding of I-prorenin to (P)RR. Aliskiren did not inhibit renin and prorenin-induced ERK 1/2 phosphorylation and kinase activity. Fluorescence-activated cell sorter analysis showed that, although fluorescein isothiocyanate-labeled HRP bound to U937 cells, HRP did not inhibit renin or prorenin-induced ERK 1/2 activation. In conclusion, prorenin and renin-induced ERK 1/2 activation are independent of angiotensin II. The signal transduction is different from that evoked by angiotensin II. Aliskiren has no (P)RR blocking effect and did not inhibit ERK 1/2 phosphorylation or kinase activity. Finally, we found no evidence that HRP affects renin or prorenin binding and signaling. Key Words: renin Ⅲ prorenin Ⅲ (pro)renin receptor Ⅲ aliskiren Ⅲ signal transduction A liskiren is a recent Food and Drug Administrationapproved, low-molecular weight, direct renin inhibitor that binds to the enzymatically active cleft of renin. Direct renin inhibition in a double-transgenic rat model of high human renin hypertension demonstrated target organ protection. 1,2 A novel (pro)renin receptor [(P)RR] has been cloned that signals when exposed to either renin or prorenin. 3 The (P)RR, correctly termed "RR/ATP6AP2," is a single transmembrane domain protein of 350 amino acids with a large unglycosylated and highly hydrophobic N-terminal domain and a short cytoplasmic tail of Ϸ20 amino acids. The (P)RR is a protein conserved among species. 4 The (P)RR enhances renin catalytic activity and allows prorenin to display catalytic activity without its proteolytic conversion to renin ("nonproteolytic activation"). Such nonproteolytic activation involves unfolding of the prosegment from the enzymatic cleft, mediated by a (P)RR-induced conformational change in the prorenin molecule. This (P)RR-induced prorenin activation could explain how prorenin exerts pathological effects in diabetic patients, where prorenin represents Յ95% of total circulating renin. Nevertheless, this hypothesis remain...

Abstract-Angiogenesis inhibition with sunitinib, a multitarget tyrosine kinase inhibitor of the vascular endothelial growth factor receptor, is associated with hypertension and cardiac toxicity, of which the underlying pathophysiological mechanism is unknown. We investigated the effects of sunitinib on blood pressure (BP), its circadian rhythm, and potential mechanisms involved, including the endothelin-1 system, in 15 patients with metastatic renal cell carcinoma or gastrointestinal stromal tumors. In addition, we investigated in rats the effect of sunitinib on BP, serum endothelin-1 levels, coronary microvascular function, cardiac structure, and cardiac mitochondrial function. In patients, BP increased by Ϸ15 mm Hg, whereas heart rate decreased after 4 weeks of treatment. Furthermore, the nocturnal dipping of BP diminished. Plasma endothelin-1 concentration increased 2-fold (PϽ0.05) and plasma renin decreased (PϽ0.05), whereas plasma catecholamines and renal function remained unchanged. In rats, 8 days of sunitinib administration induced an Ϸ30-mm Hg rise in BP, an attenuation of the circadian BP rhythm, and a 3-fold rise in serum endothelin-1 and creatinine, of which all but the rise in creatinine reversed after sunitinib withdrawal. Coronary microvascular function studies after 8 days of sunitinib administration showed decreased responses to bradykinin, angiotensin II, and sodium nitroprusside, all normalizing after sunitinib withdrawal. Cardiac structure and cardiac mitochondrial function did not change. In conclusion, sunitinib induces a reversible rise in BP in patients and in rats associated with activation of the endothelin-1 system, suppression of the renin-angiotensin system, and generalized microvascular dysfunction. (Hypertension. 2010;56:675-681.)Key Words: endothelin Ⅲ endothelial growth factors Ⅲ hypertension Ⅲ experimental Ⅲ angiogenesis Ⅲ NO A ngiogenesis, the formation of new capillaries from an existing vasculature, is critical to tumor growth, as well as metastasis. This process is regulated by numerous growth factors and their receptors, among which vascular endothelial growth factor (VEGF) and its corresponding receptors play key roles. Angiogenesis inhibition as a therapeutic strategy against malignancies was first proposed by Folkman in 1971. 1 Meanwhile, a variety of drugs, targeting VEGF or its receptors, have been approved for the treatment of several tumor types. Unfortunately, angiogenesis inhibition is associated with adverse effects, in particular, hypertension, which has been reported in Յ60% of patients treated with sunitinib, an orally active multitarget VEGF receptor tyrosine kinase inhibitor (RTKI) and one of the most commonly used angiogenesis inhibitors. 2 Decreased NO bioavailability might underlie this phenomenon. 3,4 VEGF inhibition with sunitinib is also associated with cardiac toxicity, as evidenced by a decrease in left ventricular ejection fraction in Յ28% of patients. 5 Given the sunitinib-induced changes in cardiac mitochondrial structure, this could relate to impa...

Cardiac ACE activity is highest in subjects with the DD genotype. Elevated cardiac ACE activity in these subjects may result in increased cardiac angiotensin II levels, and this may be a mechanism underlying the reported association between the ACE deletion polymorphism and the increased risk for several cardiovascular disorders.

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Aims/Background-All components necessary for the formation of angiotensin II, the biologically active product of the renin-angiotensin system (RAS) Since gene expression was highest in ocular parts, which are highly vascularised, local angiotensin II may be involved in blood supply and/or pathological vascular processes such as neovascularisation in diabetic retinopathy. (BrJ Ophthalmol 1996; 80: 159-163) The renin-angiotensin system (RAS) plays an important role in the control of blood pressure and electrolyte homeostasis. The enzyme renin cleaves its substrate, angiotensinogen, to form angiotensin I. Angiotensin I is then converted by angiotensin converting enzyme (ACE) to angiotensin II, a potent vasoconstrictor and a stimulant of aldosterone release.

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