論文

BACKGROUND/AIMS: The role of matrix metalloproteinases (MMPs) in the pathogenesis of glomerular injury appears to be complex. To investigate the role of individual MMPs, we examined the course of Adriamycin-induced albuminuria and glomerulosclerosis in mice lacking either a gelatinase (MMP-9) or a collagenase (MMP-13). METHODS: Adriamycin was administered to MMP-9 or MMP-13 knockout (KO) mice. Glomerular injury was assessed by the quantification of albuminuria, the glomerular injury score and type IV collagen immunostaining. RESULTS: Treatment of mice with Adriamycin (18 mg/kg i.v.) resulted in marked albuminuria and glomerulosclerosis reaching a peak at 4-8 weeks. The albuminuria and glomerulosclerosis were significantly (p < 0.05) attenuated in both the MMP-9 KO and MMP-13 KO mice compared to controls. In contrast, treatment of wild-type mice with the broad-spectrum MMP inhibitor doxycycline did not have a beneficial effect on the albuminuria and glomerulosclerosis. CONCLUSION: These results support a role for both gelatinase (MMP-9) and collagenase (MMP-13) in the pathogenesis of glomerular injury in the Adriamycin-induced glomerulosclerosis model. MMP inhibitors with high specificity towards MMP-9 and/or MMP-13 may be potential future candidates to provide more effective therapies to inhibit the development of glomerulosclerosis.

Hypertension is a disease which affects over 26.4% of the world adult population, therefore novel approaches to the prevention and treatment of this disease need to be examined. Previous studies from our and other laboratories have shown that treatment of spontaneously hypertensive rats (SHR) and Dahl salt-sensitive rats with a renin-angiotensin system (RAS) inhibitor during the 'critical period' in hypertension development results in prevention of the later development of hypertension. In humans, Julius et al. reported similar findings in the landmark TROPHY study. Recently, we reported that 'pulse' treatment of SHR with high-dose angiotensin receptor blocker (ARB) is effective in causing sustained reduction of already established hypertension, even when the treatment was started after the 'critical period'. These results suggest the possibility that 'regression' of established hypertension may become feasible, and we have started a prospective, multicenter clinical study (STAR CAST study) to examine this possibility. In our animal studies, we found that treatment of rats during the 'critical period' with an ARB inhibits the development of renal arteriolar hypertrophy. Moreover, a high-dose angiotensin blocker caused a remarkable reversal of renal arteriolar hypertrophy in SHR, which was associated with changes in microvascular MMP expression. These results suggest that changes in the renal microvasculature may have an important role in the mechanisms of hypertension prevention and regression by ARB.

BACKGROUND/AIMS: We have previously shown that treatment of spontaneously hypertensive rats (SHR) with an angiotensin receptor blocker (ARB) during the 'critical period' from age 3 to 10 weeks confers protection against L-NAME-induced renal injury later in life. The aim of this study was to examine the effects of transient prepubertal exposure to ARB on the development of nephropathy in streptozotocin-induced diabetic SHR and to compare the results with other antihypertensive agents including a mineralocorticoid receptor antagonist (MR-ant). METHODS: Male SHR (n = 43) were transiently treated with candesartan (ARB), potassium canreonate (the active metabolite of the MR-ant spironolactone) or hydralazine (vasodilator) between 3 and 10 weeks of age with untreated rats serving as controls. An additional group was treated continuously with candesartan throughout the study. Rats were injected with streptozotocin to induce diabetes at age 16 weeks and followed until age 8 months. RESULTS: Diabetic control rats showed signs of diabetic nephropathy including albuminuria and mesangial expansion. These changes were significantly suppressed in rats exposed to ARB or MR-ant. Systolic blood pressure was significantly reduced compared to controls in the ARB (transient) and ARB (sustained) groups, but not in the MR-ant or vasodilator groups. CONCLUSION: Transient prepubertal exposure to ARB or MR-ant, but not vasodilator, confers protection against the later development of diabetic nephropathy and involves blood pressure-independent protective mechanisms.