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肾素-血管紧张素系统调节在肝脏疾病治疗和预防中的作用。

The role of renin-angiotensin system modulation on treatment and prevention of liver diseases.

作者信息

Moreira de Macêdo Simone, Guimarães Talita Antunes, Feltenberger John David, Sousa Santos Sérgio Henrique

出版信息

Peptides. 2014 Dec;62:189-96. doi: 10.1016/j.peptides.2014.10.005.

Abstract

The renin-angiotensin system (RAS) is now recognized as an important modulator of body metabolic processes. The discovery of angiotensin-converting enzyme 2 (ACE2) has renewed interest in the potential therapeutic role of RAS modulation. Recent studies have pointed out the importance of the local balance between ACE/Ang-II/AT1 and ACE2/Ang-(1-7)/Mas arms to avoid liver metabolic diseases. Furthermore, non-alcoholic fatty liver disease is an increasing health problem that includes a spectrum of hepatic steatosis, steatohepatitis and fibrosis. Some new studies revealed that RAS imbalance appears to promote hepatic fibrogenesis; while the activation of ACE2/Ang-(1-7)/Mas counter-regulatory axis is able to prevent liver injuries. In this context, the aim of the present review is to discuss the importance of RAS in the development and prevention of liver disease. AT1 receptor activation by Ang II induces hepatic stellate cell contraction and proliferation, causes oxidative stress, endothelial dysfunction, cell growth and inflammation. In addition, both AT1 blocker administration and ACE inhibitors lead to a reduction in inflammation and improvement of hepatic fibrosis. Conversely, Ang-(1-7) infusion reduces fibrosis and proliferation mainly by suppression of hepatic stellate cell activation; Mas receptor antagonism aggravates liver fibrosis and severe liver steatosis. In conclusion, the use of ACE/Ang II/AT1 axis inhibitors associated with ACE2/Ang(1-7)/Mas axis activation is a promising new strategy serving as a novel therapeutic regimen to prevent and treat chronic liver diseases as well as acute liver injury.

摘要

肾素-血管紧张素系统(RAS)现已被公认为是身体代谢过程的重要调节因子。血管紧张素转换酶2(ACE2)的发现重新引发了人们对RAS调节潜在治疗作用的兴趣。最近的研究指出了ACE/Ang-II/AT1与ACE2/Ang-(1-7)/Mas分支之间局部平衡对避免肝脏代谢疾病的重要性。此外,非酒精性脂肪性肝病是一个日益严重的健康问题,包括一系列肝脂肪变性、脂肪性肝炎和纤维化。一些新研究表明,RAS失衡似乎会促进肝纤维化;而ACE2/Ang-(1-7)/Mas反调节轴的激活能够预防肝损伤。在此背景下,本综述的目的是讨论RAS在肝病发生和预防中的重要性。Ang II激活AT1受体可诱导肝星状细胞收缩和增殖,引起氧化应激、内皮功能障碍、细胞生长和炎症。此外,给予AT1阻滞剂和ACE抑制剂均可导致炎症减轻和肝纤维化改善。相反,输注Ang-(1-7)主要通过抑制肝星状细胞激活来减少纤维化和增殖;Mas受体拮抗作用会加重肝纤维化和严重的肝脂肪变性。总之,联合使用ACE/Ang II/AT1轴抑制剂与激活ACE2/Ang(1-7)/Mas轴是一种有前景的新策略,可作为预防和治疗慢性肝病以及急性肝损伤的新型治疗方案。

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