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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:2252.)
© 2006 American Heart Association, Inc.

Vascular Biology

Angiotensin II Type 1 Receptor–Mediated Inflammation Is Required for Choroidal Neovascularization

Norihiro Nagai; Yuichi Oike; Kanako Izumi-Nagai; Takashi Urano; Yoshiaki Kubota; Kousuke Noda; Yoko Ozawa; Makoto Inoue; Kazuo Tsubota; Toshio Suda; Susumu Ishida

From the Laboratory of Retinal Cell Biology (N.N., Y.O., K.I., Y.O., S.I.), Departments of Ophthalmology (N.N., K.I., K.N., Y.O., M.M.I., K.T., S.I.) and Cell Differentiation (N.N., Y.O., T.U., Y.K., T.S.), Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

Correspondence to Susumu Ishida, MD, PhD, Laboratory of Retinal Cell Biology, Department of Ophthalmology, Keio University School of Medicine; 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail ishidasu{at}sc.itc.keio.ac.jp

Background— Choroidal neovascularization (CNV) is a critical pathogenesis in age-related macular degeneration, the most common cause of blindness in the developed countries. The aim of the current study was to determine the involvement of the renin-angiotensin system (RAS) with the development of CNV, using human surgical samples and the murine model of laser-induced CNV.

Methods and Results— In the human and murine CNV tissues, the vascular endothelium expressed angiotensin II type 1 receptor (AT1-R), AT2-R, and angiotensin II. The CNV volume was significantly suppressed by treatment with an AT1-R blocker telmisartan, but not with an AT2-R blocker. AT1-R signaling blockade with telmisartan inhibited various inflammatory mechanisms including macrophage infiltration and upregulation of VEGF, intercellular adhesion molecule-1 (ICAM-1), MCP-1, and IL-6 in the retinal pigment epithelium-choroid complex. A PPAR- antagonist partially but significantly reversed the suppressive effect of telmisartan on in vivo induction of CNV and in vitro upregulation of ICAM-1 and MCP-1 in endothelial cells and IL-6 in macrophages, showing the dual contribution of PPAR--agonistic and AT1-R-antagonistic actions in the telmisartan treatment.

Conclusions— AT1-R–mediated inflammation plays a pivotal role in the development of CNV, indicating the possibility of AT1-R blockade as a novel therapeutic strategy to inhibit CNV.

We analyzed the involvement of the renin-angiotensin system with the development of choroidal neovascularizaron (CNV), using human surgical samples and the murine model of laser-induced CNV and revealed that angiotensin II type 1 receptor-mediated inflammation, including macrophage infiltration and cytokine upregulation, plays a pivotal role in the development of CNV.

Key Words: choroidal neovascularization • inflammation • intercellular adhesion molecule-1 • renin-angiotensin system • vascular endothelial growth factor

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