Objective-Permeability of blood vessels is essential for tissue homeostasis. However, disorganized hyperpermeability leads to progression of diseases. Vascular endothelial growth factor-A (VEGF) is a key regulator for leakiness of blood vessels and it has been reported that VEGF-mediated hyperpermeability was suppressed by angiopoietin-1 (Ang1). We found that Angiotensin-converting enzyme (ACE) was downregulated in endothelial cells by Ang1. ACE converts angiotensin I to angiotensin II (AII). Here, we studied the relationship between VEGF and AII relative to vascular permeability. Methods and Results-We showed that VEGF-mediated vascular hyperpermeability was suppressed in mice given AII type 1 receptor (AT1R) blocker (ARB); the effect was also seen in AT1R-deficient mice. In this system, we found that ARB inhibited VEGF-induced gap formation. Furthermore, we ascertained that angioedema induced by overexpression of VEGF decreased noticeably in ARB-treated ischemic mice. Conclusions-Because ARB suppressed VEGF-induced vascular hyperpermeability, we propose that ARB may be used to minimize the risk of edema in therapeutic angiogenesis using VEGF. Key Words: VEGF Ⅲ Tie2 Ⅲ angiotensin-converting enzyme Ⅲ gene therapy Ⅲ VE-cadherin I t has been widely believed that vascular endothelial growth factor-A (VEGF) can rapidly induce hyperpermeability in the adult and that VEGF-induced vascular leakage through VEGF receptor, VEGFR2/Flk-1, may lead to edema and swelling and contribute to many disease processes including brain tumors, diabetic retinopathy, ischemic strokes, sepsis, and also inflammatory conditions such as rheumatoid arthritis and asthma. 1 It has been reported that the vascular leakage induced by VEGF could be blocked by acute administration of angiopoietin-1 (Ang1). 2 Ang1 and VEGF are endothelial cell (EC)-specific growth factors. Ang1 induces angiogenic signals through the Tie2 receptor tyrosine kinase, which is expressed on ECs and hematopoietic stem cells. 3 An Ang1 relative, termed angiopoietin-2 (Ang2), was shown to be a naturally occurring antagonist for Ang1 and Tie2. Ang1 and Ang2 are essential for normal vascular development in the mouse. VEGF also has been shown to be required for blood vessel formation during embryogenesis 4,5 and to augment postnatal angiogenesis. 6 Despite the fact that VEGF was initially called vascular permeability factor, there has been less focus on its permeability actions and more efforts have been devoted to its clinical application for ischemia and cancer. Actually, direct comparison of transgenic mice overexpressing VEGF in the skin revealed that blood vessels induced by VEGF were leaky, 7 whereas those induced by Ang1 were not leaky. 8 Furthermore, blood vessels in Ang1-overexpressing mice were resistant to leakiness caused by inflammatory stimulation and VEGF. 2 In contrast to Ang1, transgenic overexpression of Ang2 on ECs disrupts blood vessel formation by disrupting the interaction of ECs and mural cells (MCs) in the mouse embryo; this is also observed in Tie2-or A...