title: Interference of angiotensin-converting enzyme inhibitors on erythropoiesis in kidney transplant recipients: role of growth factors and cytokines.
abstract: BACKGROUND
  Recent data indicate that factors other than erythropoietin (EPO), such as insulin-like growth factor 1 (IGF-1), can promote erythropoiesis in vitro and correct the anemia of chronic renal failure in vivo. IGF-1 is produced by the liver under growth hormone control, as well as by other sources, including the kidney. The erythropoietic role of growth factors and cytokines and their possible modulation by angiotensin-converting enzyme inhibitors (ACEI) has never been explored.
  
  
  METHODS
  This study evaluated the serum levels of EPO, IGF-1, interleukin (IL)-2, IL-3, and granulocyte macrophage-colony-stimulating factor in 40 kidney transplanted patients with or without posttransplant erythrocytosis (PTE) and in 10 living kidney donors. Then, the effect of ACEI therapy on the above pattern was examined in patients with PTE.
  
  
  RESULTS
  EPO and IGF-1 serum levels were significantly higher in patients with PTE than in patients without PTE and in living kidney donor subjects. ACEI therapy significantly reduced hematocrit (Hct) as well as circulating IGF-1 and EPO levels. Of note, the decrease in IGF-1 was prominent mainly in those patients whose EPO levels were not significantly modified by ACEI therapy. In all of the patients Hct levels displayed a direct relationship with circulating IGF-1 levels, but not with EPO concentration. Growth hormone did not significantly differ among the groups examined, whereas it steeply increased under ACEI. Finally, no significant difference in IL-2, IL-3, and granulocyte macrophage-colony-stimulating factor serum levels was detected.
  
  
  CONCLUSIONS
  IGF-1 seems to play a role in the ACEI-related decrease of Hct in patients with PTE, chiefly in patients without any modification of EPO serum levels.
authors.affiliation: Istituto di Nefrologia, Università di Bari, Policlinico Bari, Italy.
authors.forename: L F
authors.initials: LF
authors.lastname: Morrone
authors.forename: S
authors.initials: S
authors.lastname: Di Paolo
authors.forename: F
authors.initials: F
authors.lastname: Logoluso
authors.forename: A
authors.initials: A
authors.lastname: Schena
authors.forename: G
authors.initials: G
authors.lastname: Stallone
authors.forename: F
authors.initials: F
authors.lastname: Giorgino
authors.forename: F P
authors.initials: FP
authors.lastname: Schena
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004906:Erythrocyte Count; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000097:blood; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007376:Interleukin-2 / Q000097:blood; D007377:Interleukin-3 / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D007958:Leukocyte Count; D008297:Male; D010976:Platelet Count; D011086:Polycythemia; D012044:Regression Analysis; D014019:Tissue Donors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins; D007376:Interleukin-2; D007377:Interleukin-3; D004921:Erythropoietin; D007334:Insulin-Like Growth Factor I; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003404:Creatinine