Habib Yasser H, Khattab Mahmoud, Gowayed Mennatallah A
Zi Diligence Center-Quality Pharmaceutical Services, Cairo, Egypt.
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Inflammopharmacology. 2025 Aug 12. doi: 10.1007/s10787-025-01890-z.
The renin-angiotensin system (RAS) is a pivotal hormonal regulator of cardiovascular and renal homeostasis, recently implicated in the etiology and progression of inflammatory arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA). This review explores the dual nature of RAS, highlighting its classical axis (ACE/Ang II/AT1R), which promotes inflammation and tissue damage, and its counter-regulatory axis (ACE2/Ang-(1-7)/MasR), which exhibits anti-inflammatory and protective effects. Elevated levels of RAS components in synovial fluid of arthritis patients emphasize its role in local joint pathology. The potential of RAS inhibitors, including angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs), is discussed, demonstrating their efficacy in reducing inflammatory cytokines, oxidative stress, and immune dysregulation. Emerging research also underscores the protective effects of the counter-regulatory axis in mitigating inflammation, oxidative stress, and angiogenesis, which are crucial in arthritis progression. The review further explores innovative therapeutic strategies, such as AI-powered personalized and tailored medicine, to optimize RAS-targeted therapies for enhanced efficacy and patient-specific outcomes. This evolving field highlights the promise of integrating RAS modulation with advanced diagnostic and therapeutic technologies to revolutionize arthritis treatment, offering hope for better disease management and improved quality of life.
肾素-血管紧张素系统（RAS）是心血管和肾脏稳态的关键激素调节因子，最近被认为与包括类风湿关节炎（RA）和骨关节炎（OA）在内的炎症性关节炎的病因和进展有关。本综述探讨了RAS的双重性质，强调其经典轴（ACE/Ang II/AT1R），该轴促进炎症和组织损伤，以及其反调节轴（ACE2/Ang-(1-7)/MasR），该轴具有抗炎和保护作用。关节炎患者滑液中RAS成分水平升高，强调了其在局部关节病理中的作用。讨论了包括血管紧张素受体阻滞剂（ARBs）和血管紧张素转换酶抑制剂（ACEIs）在内的RAS抑制剂的潜力，证明了它们在减少炎症细胞因子、氧化应激和免疫失调方面的功效。新兴研究还强调了反调节轴在减轻炎症、氧化应激和血管生成方面的保护作用，这些在关节炎进展中至关重要。该综述进一步探讨了创新治疗策略，如人工智能驱动的个性化和定制药物，以优化针对RAS的治疗，提高疗效并实现患者特异性结果。这个不断发展的领域突出了将RAS调节与先进诊断和治疗技术相结合以彻底改变关节炎治疗的前景，为更好的疾病管理和改善生活质量带来希望。
