Abstract-Tacrolimus (FK 506) is a powerful, widely used immunosuppressant. The clinical utility of FK 506 is complicated by substantial hypertension and nephrotoxicity. To clarify the mechanisms of FK 506 -induced hypertension, we studied the chronic effects of FK 506 on the synthesis of endothelin-1 (ET-1), the expression of mRNA of ET-1 and endothelin-converting enzyme-1 (ECE-1), the endothelial nitric oxide synthase (eNOS) activity, and the expression of mRNA of eNOS and C-type natriuretic peptide (CNP) in rat blood vessels. In addition, the effect of the specific endothelin type A receptor antagonist FR 139317 on FK 506 -induced hypertension in rats was studied. FK 506, 5 mg ⅐ kg Ϫ1 ⅐ d Ϫ1 given for 4 weeks, elevated blood pressure from 102Ϯ13 to 152Ϯ15 mm Hg and increased the synthesis of ET-1 and the levels of ET-1 mRNA in the mesenteric artery (240% and 230%, respectively). Little change was observed in the expression of ECE-1 mRNA and CNP mRNA. FK 506 decreased eNOS activity and the levels of eNOS mRNA in the aorta (48% and 55%, respectively). The administration of FR 139317 (10 mg ⅐ kg Ϫ1 ⅐ d
Ϫ1) prevented FK 506 -induced hypertension in rats. These results indicate that FK 506 may increase blood pressure not only by increasing ET-1 production but also by decreasing NO synthesis in the vasculature. 1,2 FK 506 is 10 to 100 times more potent than cyclosporin (CysA). 3 The nephrotoxic side effects of CysA and the development of hypertension observed during CysA treatment also seem to be characteristic side effects of FK 506. 4 The incidence of hypertension in previously normotensive liver or heart transplant recipients treated with CysA has been reported to be 80% to 90%.5 A lower incidence (50% to 70%) of hypertension in FK 506 -treated recipients has been reported. 6 Although renal dysfunction is usually also present in transplant recipients treated with CysA or FK 506, blood pressure elevations have been observed in the absence of detectable renal dysfunction. 7,8 The exact mechanism of FK 506 -induced hypertension is unclear, but several researchers have suggested that the primary pathogenic mechanism may be vascular. 9 We have reported that CysA and FK 506 both increased the synthesis of endothelin-1 (ET-1) in cultured vascular endothelial cells.
10The natriuretic peptides organize a family of 3 distinct peptides (atrial natriuretic peptide [ANP], brain natriuretic peptide [BNP], and C-type natriuretic peptide [CNP]) and are involved in body fluid homeostasis and blood pressure control. CNP is reported to be synthesized in the vascular endothelial cells and to possess local effects of vascular tone and remodeling.11 Nitric oxide (NO) is synthesized from L-arginine by 2 enzymes. The generation of NO by constitutive, Ca 2ϩ -dependent NO synthase (NOS) from the vascular endothelium plays an important role in the homeostasis of the vascular system. Three isoforms of NOS have been cloned from rat brain (nNOS), vascular endothelium (eNOS), and inducible Ca 2ϩ -independent enzyme (iNOS). Vascular eNOS mainta...