Angiotensin II type 1 receptor blockade attenuates in-stent restenosis by inhibiting inflammation and progenitor cells

Hypertension. 2006 Oct;48(4):664-70. doi: 10.1161/01.HYP.0000237974.74488.30. Epub 2006 Aug 28.

Abstract

The precise mechanism by which angiotensin II type 1 receptor blocker reduces in-stent restenosis in clinical trials is unclear. We, therefore, investigated the mechanism of in-stent neointima formation. Male cynomolgus monkeys and rabbits were fed a high-cholesterol diet and were allocated to untreated control and type 1 receptor blocker groups. Five days after grouping, multilink stents were implanted in the iliac artery. The type 1 receptor blocker reduced the development of in-stent neointima formation by approximately 30% in rabbits and monkeys. To investigate potential mechanisms, we examined the expression of renin-angiotensin system markers, all of which increased in monocytes and smooth muscle-like cells in the neointima and media within 7 days. The type 1 receptor blocker attenuated increased oxidative stress, the enhanced expression of markers of the rennin-angiotensin system and monocyte chemoattractant protein-1, and macrophage infiltration. The effects of type 1 receptor blocker on the differentiation of peripheral blood mononuclear cells into vascular progenitor cells were also examined. Treatment with type 1 receptor blocker suppressed the enhanced differentiation to smooth muscle progenitor cells induced by stenting. The type 1 receptor blocker attenuated in-stent neointima formation by inhibiting redox-sensitive inflammatory changes and by reducing recruitment of the progenitor cells. These potential actions of type 1 receptor blocker on inflammation and progenitor cells constitute a novel mechanism of suppression of in-stent restenosis by type 1 receptor blocker.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiotensin II Type 1 Receptor Blockers / blood
  • Angiotensin II Type 1 Receptor Blockers / pharmacology*
  • Animals
  • Apoptosis / drug effects
  • Biomarkers / metabolism
  • Blood Pressure / drug effects
  • Blood Vessels / pathology
  • Cell Differentiation / drug effects
  • Constriction, Pathologic
  • Iliac Artery*
  • Imidazoles / pharmacology
  • Inflammation / prevention & control*
  • Inflammation Mediators / antagonists & inhibitors
  • Isoenzymes / antagonists & inhibitors
  • Macaca fascicularis
  • Male
  • Monocytes / metabolism
  • Monocytes / pathology
  • Myocytes, Smooth Muscle / metabolism
  • Myocytes, Smooth Muscle / pathology
  • NADPH Oxidases / antagonists & inhibitors
  • Oxidative Stress / drug effects
  • Rabbits
  • Recurrence
  • Renin-Angiotensin System
  • Stem Cells / pathology*
  • Stents / adverse effects*
  • Tetrazoles / pharmacology
  • Tunica Intima / drug effects*
  • Tunica Intima / growth & development*
  • Tunica Intima / metabolism
  • Valine / analogs & derivatives
  • Valine / pharmacology
  • Valsartan

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Biomarkers
  • Imidazoles
  • Inflammation Mediators
  • Isoenzymes
  • Tetrazoles
  • Valsartan
  • olmesartan
  • NADPH Oxidases
  • Valine