Angiotensin II receptor antagonists prevent neointimal proliferation in a porcine coronary artery organ culture model.
OBJECTIVE
Angiotensin II (AngII) generation in response to vascular injury has long been assumed to influence neointimal proliferation contributing to restenosis. This concept has been supported by evidence that ACE inhibition and AT1 receptor blockade effectively limits restenosis in the rat. On the other hand, ACE inhibition has proven ineffective in clinical trails. The present study examines the response of the porcine coronary artery after angioplasty in vitro and compares the actions of an ACE inhibitor to AngII receptor antagonists.


RESULTS
Captopril, an ACE inhibitor, and the AngII receptor antagonists, losartan and PD123319, were evaluated for their ability to attenuate neointimal proliferation in a porcine organ culture model of coronary restenosis. The neointima was significantly increased by 300% after angioplasty compared to non-angioplasty controls. The AT1 receptor antagonist, losartan, produced a significant reduction in neointimal index at 10(-5) mol/l, while its in vivo metabolite, EXP3174, reduced neointimal proliferation at 10(-6) mol/l. PD123319, a selective antagonist of the AT2 receptor, also restricted neointimal proliferation at 10(-5) mol/l. Treatment with captopril (10(-6) mol/l) increased the neointimal proliferation by approximately 200% after angioplasty.


CONCLUSIONS
Direct blockade of AngII receptors effectively inhibits cell proliferation and restenosis post-angioplasty in vitro. ACE inhibition, exclusive of flow, does not attenuate proliferative restenosis. These data suggest that AngII contributes to neointimal proliferation and validates the concept that receptor antagonists could contribute to the therapeutic management of restenosis.
Wilson
D P
DP
Department of Physiology, University of Manitoba, Canada.
Saward
L
L
Zahradka
P
P
Cheung
P K
PK
D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D000804:Angiotensin II; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D002455:Cell Division / Q000187:drug effects; D003327:Coronary Disease / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D003331:Coronary Vessels; D046508:Culture Techniques; D007093:Imidazoles / Q000627:therapeutic use*; D019808:Losartan / Q000627:therapeutic use*; D009131:Muscle, Smooth, Vascular / Q000187:drug effects / Q000473:pathology; D011725:Pyridines / Q000627:therapeutic use*; D012008:Recurrence; D013552:Swine; D013777:Tetrazoles / Q000627:therapeutic use
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007093:Imidazoles; D011725:Pyridines; D013777:Tetrazoles; D000804:Angiotensin II; C073402:PD 123319; D002216:Captopril; C066026:losartan carboxylic acid; D019808:Losartan