title: AT1 receptor blocker losartan protects against mechanical ventilation-induced diaphragmatic dysfunction.
abstract: Mechanical ventilation is a life-saving intervention for patients in respiratory failure. Unfortunately, prolonged ventilator support results in diaphragmatic atrophy and contractile dysfunction leading to diaphragm weakness, which is predicted to contribute to problems in weaning patients from the ventilator. While it is established that ventilator-induced oxidative stress is required for the development of ventilator-induced diaphragm weakness, the signaling pathway(s) that trigger oxidant production remain unknown. However, recent evidence reveals that increased plasma levels of angiotensin II (ANG II) result in oxidative stress and atrophy in limb skeletal muscles. Using a well-established animal model of mechanical ventilation, we tested the hypothesis that increased circulating levels of ANG II are required for both ventilator-induced diaphragmatic oxidative stress and diaphragm weakness. Cause and effect was determined by administering an angiotensin-converting enzyme inhibitor (enalapril) to prevent ventilator-induced increases in plasma ANG II levels, and the ANG II type 1 receptor antagonist (losartan) was provided to prevent the activation of ANG II type 1 receptors. Enalapril prevented the increase in plasma ANG II levels but did not protect against ventilator-induced diaphragmatic oxidative stress or diaphragm weakness. In contrast, losartan attenuated both ventilator-induced oxidative stress and diaphragm weakness. These findings indicate that circulating ANG II is not essential for the development of ventilator-induced diaphragm weakness but that activation of ANG II type 1 receptors appears to be a requirement for ventilator-induced diaphragm weakness. Importantly, these experiments provide the first evidence that the Food and Drug Administration-approved drug losartan may have clinical benefits to protect against ventilator-induced diaphragm weakness in humans.
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Oh Sung
authors.initials: OS
authors.lastname: Kwon
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Smuder
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wiggs
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Hall
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Kurt J
authors.initials: KJ
authors.lastname: Sollanek
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Morton
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
authors.forename: Erin E
authors.initials: EE
authors.lastname: Talbert
authors.affiliation: Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida; and Geriatric Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida.
authors.forename: Hale Z
authors.initials: HZ
authors.lastname: Toklu
authors.affiliation: Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida; and Geriatric Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida.
authors.forename: Nihal
authors.initials: N
authors.lastname: Tumer
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida; spowers@hhp.ufl.edu.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Powers
mesh_terms: D000804:Angiotensin II / Q000097:blood; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D003964:Diaphragm / Q000187:drug effects / Q000378:metabolism*; D004656:Enalapril / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D019808:Losartan / Q000494:pharmacology / Q000627:therapeutic use*; D018908:Muscle Weakness / Q000209:etiology / Q000378:metabolism* / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012121:Respiration, Artificial / Q000009:adverse effects*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000804:Angiotensin II; D004656:Enalapril; D019808:Losartan
keywords: muscle atrophy; reactive oxygen species; respiratory muscles; weaning