Abstract. Treatment with angiotensin type 1 receptor blockers (ARBs) is known to improve renal dysfunction and glucose metabolism in obese diabetic animal models and humans. This study examined the effects of irbesartan, a unique ARB with PPARγ activation, on endothelial dysfunction, renal dysfunction, abnormal lipid profile, and liver dysfunction in obese fa/fa Zucker diabetic fatty (ZDF) rats. ZDF rats were administered irbesartan (30 mg/kg/day p.o.) for 12 weeks. Blood pressure, glucose metabolism, lipid profile and renal function were measured every 4 weeks. Response of mesenteric artery rings to acetylcholine was also evaluated as an index of endothelial function after 12 weeks of treatment. Although irbesartan did not affect glucose and insulin levels in both glucose and insulin tolerance tests, decreases in systolic blood pressure, dyslipidemia, and urinary protein excretion were noted from 4 weeks after the start of treatment and continued until 12 weeks. Endothelial and liver dysfunctions were also improved after 12 weeks of treatment. Compared to previous reports showing the effects of irbesartan at later time points such as 6 or 12 months, the present study demonstrated that a low-dose of irbesartan had favorable effects from the early period of treatment, independent of glucose metabolism. Our findings suggest that a low-dose of irbesartan improves diabetic complications quickly after starting treatment, and may support the use of irbesartan for preventing progression of diabetic complications.
IntroductionDiabetic angiopathy, nephropathy, and dyslipidemia are important risk factors for multiple organ dysfunctions such as ischemic heart disease and chronic renal failure. There is growing evidence that angiotensin (Ang) II plays a key role in the activation of inflammation and oxidative stress, which accelerate the progression of such diseases through the Ang II type 1 receptor (AT1R) (1-3). Based on this viewpoint, the prevention of Ang II signaling by AT1R blockers (ARBs) has been extensively used in diabetic patients (1,2). Among them, irbesartan, a so-called metabosartan, is a unique ARB with the ability to increase the transcriptional activity of PPAR-γ, which was found to decrease pro-inflammatory cytokines in monocytes (4) and prevent up-regulation of MCP-1 receptor expression in animal studies (5). Since irbesartan stimulated PPAR-γ activity in an AT1R-deficient cell model, the stimulatory effect of irbesartan on PPAR-γ activity is independent of its AT1R blockade (6). Importantly, two large prospective, randomized, double-blind clinical trials demonstrated that irbesartan prevented the onset (7) and progression of chronic kidney disease (8), independent of its blood pressure-lowering effect. Additionally, endothelial dysfunction was significantly improved by short-term atorvastatin and/or irbesartan in type 2 diabetic patients without affecting blood pressure (2). These data suggest that irbesartan could have organ-protective actions independent of blood pressure lowering, possibly due to PPA...