Distinct cardiac and renal effects of eta receptor antagonist and ace inhibitor in experimental type 2 diabetes

Carla Zoja, Sara Cattaneo, Fabio Fiordaliso, Vincenzo Lionetti, Vanessa Zambelli, Monica Salio, Daniela Corna, Chiara Pagani, Daniela Rottoli, Cinzia Bisighini, Giuseppe Remuzzi, Ariela Benigni

Research output: Contribution to journalArticlepeer-review


Abstract Diabetic nephropathy is associated with cardiovascular morbidity. Angiotensin-converting enzyme (ACE) inhibitors provide imperfect renoprotection in advanced type 2 diabetes, and cardiovascular risk remains elevated. Endothelin (ET)-1 has a role in renal and cardiac dysfunction in diabetes. Here, we assessed whether combination therapy with an ACE inhibitor and ETA receptor antagonist provided reno-and cardioprotection in rats with overt type 2 diabetes. Four groups of Zucker diabetic fatty (ZDF) rats were treated orally from 4 (when proteinuric) to 8 mo with vehicle, ramipril (1 mg/kg), sitaxsentan (60 mg/kg), and ramipril plus sitaxsentan. Lean rats served as controls. Combined therapy ameliorated proteinuria and glomerulosclerosis mostly as a result of the action of ramipril. Simultaneous blockade of ANG II and ET-1 pathways normalized renal monocyte chemoattractant protein-1 and interstitial inflammation. Cardiomyocyte loss, volume enlargement, and capillary rarefaction were prominent abnormalities of ZDF myocardium. Myocyte volume was reduced by ramipril and sitaxsentan, which also ameliorated heart capillary density. Drug combination restored myocardial structure and reestablished an adequate capillary network in the presence of increased cardiac expression of VEGF/VEGFR-1, and significant reduction of oxidative stress. In conclusion, in type 2 diabetes concomitant blockade of ANG II synthesis and ET-1 biological activity through an ET A receptor antagonist led to substantial albeit not complete renoprotection, almost due to the ACE inhibitor. The drug combination also showed cardioprotective properties, which however, were mainly dependent on the contribution of the ET A receptor antagonist through the action of VEGF.

Original languageEnglish
JournalAmerican Journal of Physiology - Renal Physiology
Issue number5
Publication statusPublished - Nov 2011


  • Endothelin-1
  • Vegf/vegfr-1
  • Zucker diabetic fatty rats

ASJC Scopus subject areas

  • Physiology
  • Urology


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