title: The renin-angiotensin system in lupus: physiology, genes and practice, in animals and humans.
abstract: Although multiple studies suggest a potential role for angiotensin II in inflammation, most were performed either in vitro or in animals with non-immune-complex-mediated diseases. Extrapolation of these findings to humans, particularly patients with lupus, which involves multiple immunoregulatory pathways, is unclear. In autoimmune-prone MRL/lpr mice, angiotensin-converting-enzyme (ACE) inhibition improved survival although to a lesser degree than cyclophosphamide and diminished the glomerular histopathologic damage, proteinuria, lymphoid hyperplasia, dermatitis, and hypergammaglobulinemia, with a reduction in TGF-beta1 and beta 2 expression in the kidneys and renal chemokine mRNA expression. Spleen levels of IL-4 and IL-10 were also reduced. Uncontrolled studies in patients with treatment-refractory lupus nephritis showed a significant reduction in proteinuria with ACE-inhibitors and Angiotensin receptor blockers treatment. The 'masking' effect of ACE-inhibitors should be taken into consideration, as an exacerbation of lupus nephritis may be missed when estimated by the magnitude of proteinuria, which is decreased by these treatments. No single ACE genotype was consistently associated with subsets of SLE patients. In retrospective analyses, ACE-inhibitor use predicted a favourable outcome in 94 cases of pauci-immune vasculitis. The attenuating effect of angiotensin II inhibitors on the progression of chronic renal disease is well recognized. The data on the role of this intervention in lupus is limited.
authors.affiliation: Immunology/Allergy Unit, Rabin Medical Center, Petah Tiqwa, Israel. teplit@zahav.net.il
authors.forename: V
authors.initials: V
authors.lastname: Teplitsky
authors.forename: Y
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: A
authors.initials: A
authors.lastname: Tanay
mesh_terms: D000804:Angiotensin II / Q000502:physiology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D001327:Autoimmune Diseases / Q000503:physiopathology; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000235:genetics / Q000503:physiopathology*; D008181:Lupus Nephritis / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D051379:Mice; D007703:Peptidyl-Dipeptidase A / Q000235:genetics / Q000502:physiology; D012084:Renin-Angiotensin System / Q000502:physiology*; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000804:Angiotensin II; D007703:Peptidyl-Dipeptidase A