title: A vaccine for hypertension based on virus-like particles: preclinical efficacy and phase I safety and immunogenicity.
abstract: BACKGROUND
  Despite the availability of efficacious drugs, the success of treating hypertension is limited by patients' inconsistent drug intake. Immunization against angiotensin II may offer a valuable alternative to conventional drugs for the treatment of hypertension, because vaccines induce relatively long-lasting effects and do not require daily dosing. Here we describe the preclinical development and the phase I clinical trial testing of a virus-like particle (VLP)-based antihypertensive vaccine.
  
  
  RESULTS
  An angiotensin II-derived peptide was conjugated to the VLP Qbeta (AngQb). AngQb was highly immunogenic in mice and rats. To test for efficacy, spontaneously hypertensive rats (SHR) were immunized with 400 microg AngQb or VLP alone. Group mean systolic blood pressure (SBP) was reduced by up to 21 mmHg (159 +/- 2 versus 180 +/- 5 mmHg, P < 0.001), and total angiotensin II levels (antibody-bound and free) were increased ninefold (85 +/- 20 versus 9 +/- 1 pmol/l, P = 0.002) compared with VLP controls. SHR treated with the angiotensin-converting enzyme (ACE) inhibitor ramipril (1 mg/kg per day by mouth) reached an SBP of 155 +/- 2 mmHg. Twelve healthy volunteers of a placebo-controlled randomized phase I trial were injected once with 100 microg AngQb. Angiotensin II-specific antibodies were raised in all subjects (100% responder rate) and AngQb was well tolerated.
  
  
  CONCLUSIONS
  AngQb reduces blood pressure in SHR to levels obtained with an ACE inhibitor, and is immunogenic and well tolerated in humans. Therefore, vaccination against angiotensin II has the potential to become a useful antihypertensive treatment providing long-lasting effects and improving patient compliance.
authors.affiliation: Renal Division, University Hospital, Zurich, Switzerland.
authors.forename: Patrice M
authors.initials: PM
authors.lastname: Ambühl
authors.forename: Alain C
authors.initials: AC
authors.lastname: Tissot
authors.forename: Alma
authors.initials: A
authors.lastname: Fulurija
authors.forename: Patrik
authors.initials: P
authors.lastname: Maurer
authors.forename: Juerg
authors.initials: J
authors.lastname: Nussberger
authors.forename: Robert
authors.initials: R
authors.lastname: Sabat
authors.forename: Vera
authors.initials: V
authors.lastname: Nief
authors.forename: Charlotte
authors.initials: C
authors.lastname: Schellekens
authors.forename: Katja
authors.initials: K
authors.lastname: Sladko
authors.forename: Kirsten
authors.initials: K
authors.lastname: Roubicek
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfister
authors.forename: Manfred
authors.initials: M
authors.lastname: Rettenbacher
authors.forename: Hans-Dieter
authors.initials: HD
authors.lastname: Volk
authors.forename: Frank
authors.initials: F
authors.lastname: Wagner
authors.forename: Philipp
authors.initials: P
authors.lastname: Müller
authors.forename: Gary T
authors.initials: GT
authors.lastname: Jennings
authors.forename: Martin F
authors.initials: MF
authors.lastname: Bachmann
mesh_terms: D000328:Adult; D000804:Angiotensin II / Q000097:blood / Q000276:immunology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000918:Antibody Specificity; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use* / Q000633:toxicity; D001323:Autoantibodies / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D004195:Disease Models, Animal; D004311:Double-Blind Method; D004353:Drug Evaluation, Preclinical; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D010349:Patient Compliance; D017257:Ramipril / Q000627:therapeutic use; D051381:Rats; D011918:Rats, Inbred SHR; D012016:Reference Values; D013997:Time Factors; D014612:Vaccines / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use* / Q000633:toxicity; D014771:Virion / Q000276:immunology*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001323:Autoantibodies; D014612:Vaccines; D000804:Angiotensin II; D017257:Ramipril