Generation of angiotensin I by tissues of the human female genital tract

Therapeutic opportunities in targeting the protective arm of the renin-angiotensin system to improve insulin sensitivity: a mechanistic review

In recent years, the knowledge of the physiological and pathophysiological roles of the renin-angiotensin system (RAS) in glucose metabolism has advanced significantly. It is now well-established that blockade of the angiotensin AT1 receptor (AT1R) improves insulin sensitivity. Activation of the AT2 receptor (AT2R) and the MAS receptor are significant contributors to this beneficial effect. Elevated availability of angiotensin (Ang) II) for interaction with the AT2R and increased Ang-(1-7) formation during AT1R blockade mediate these effects. The ongoing development of selective AT2R agonists, such as compound 21 and the novel Ang III peptidomimetics, has significantly advanced the exploration of the role of AT2R in metabolism and its potential as a therapeutic target. These agents show promise, particularly when RAS inhibition is contraindicated. Additionally, other RAS peptides, including Ang IV, des-Asp-Ang I, Ang-(1-9), and alamandine, hold therapeutic capability for addressing metabolic disturbances linked to type 2 diabetes. The possibility of AT2R heteromerization with either AT1R or MAS receptor offers an exciting area for future research, particularly concerning therapeutic strategies to improve glycemic control. This review focuses on therapeutic opportunities to improve insulin sensitivity, taking advantage of the protective arm of the RAS.

Sodium balance in pregnancy

Sodium is the major cation in the extracellular fluid volume (ECFV) and as such, is the most important determinant of osmolality and of the volume of this fluid compartment. Hence any alteration in the control of body sodium will be reflected by changes in the ECFV, including the maternal plasma volume. There is no doubt that expansion of the plasma volume is a necessary and desirable event during pregnancy, influencing positively both maternal and fetal outcome. Therefore, studies of sodium balance in pregnancy provide important information relevant to both mother and fetus.

The human placental renin-angiotensin system

The human placenta and related tissues are considered to be examples of the recently accepted local renin-angiotensin systems (RAS). The brain is another example of a system that is thought to be regulated independently of the kidney and the role of angiotensin within the CNS as a neural mediator has drawn considerable attention. It has been known for a long time that many of the neuroendocrine mediators and receptors are expressed in the placenta and it has been suggested that there are many parallels between the classical neuroendocrine system and the placental one. The present review summarizes information that components of the RAS are expressed in uteroplacental tissues, are regulated by endogenous substances, and have important biological functions within this reproductive system. A comparison of similarities and differences between the classical and the placental RAS may provide clues to functions in other endocrine and neuroendocrine systems. The major components of the placental RAS that are considered are renin, prorenin, angiotensin I, angiotensin II, angiotensin converting enzyme (ACE), angiotensin receptors, and angiotensinogen (renin substrate). The factors that regulate these components at the cellular and the nuclear level are described. It is concluded that prorenin via angiotensin-dependent and angiotensin-independent mechanisms influences functions within uteroplacental tissues. Some of these actions are direct and others are mediated by the release of different signalling molecules. These features are similar to many neuroendocrine systems and utilize some of the same messengers.

Renin-like immunoreactivity in human placenta and fetal membranes

Five antibodies that stained renin in the kidney were used to investigate the presence of renin in human placenta and fetal membranes. Despite a large number of experimental approaches to enhance penetration of the immunoglobulins, only two of them showed immunostaining in placenta and fetal membranes. Staining was found in placental syncytiotrophoblast, the amnionic epithelium overlying the placenta, and in glandular epithelial cells present in the decidua adhering to the fetal membranes. It was most consistent, however, in a small infiltrating cell type dispersed through the fetoplacental layers. The two antibodies that revealed immunostaining in all preparations showed high affinity cross-reactivity with cathepsin D. Among other, less plausible, explanations, this raises the possibility that the bulk of 'renin' found in placenta and fetal membranes is not identical to renal renin, but may be cathepsin D or a substance related to both cathepsin D and renin.

Identification of 'renin'-containing cells in the choriodecidua

Chorionic trophoblast, decidual cells, and macrophages have all been named as the site of renin in the placental membranes. To establish more clearly the nature of the renin-containing cells in the placental membranes, double immunostaining techniques were used to stain renin and specific cell markers in the same tissue sections. Cytokeratin was selected as an ectodermal cell marker and CD68 as a cytoplasmic macrophage marker. Cross-binding between antibodies was prevented by blocking species-related binding sites between the first and second sequence of the double-immunostaining procedures and by using highly selective immunostaining techniques in the second sequence. The results clearly show renin immunostaining in CD68-positive macrophages and not in cytokeratin-positive trophoblast. The anti-renal renin monoclonal antibody showed high affinity cross-reactivity with cathepsin D, another aspartic proteinase that can release angiotensin I from angiotensinogen. This should be seen in the context of earlier findings that only two of four anti-renal renin monoclonal antibodies showed staining in uterine and placental tissues and both cross-reacted with cathepsin D. The results indicate that differentiation between renin and cathepsin D and, possibly, other substances with shared properties and epitope homology deserves more attention than it has received thus far.

Volume homeostasis in normal and hypertensive human pregnancy

In this chapter are outlined the many factors involved in the regulation of sodium and volume homeostasis in normal human pregnancy and their interrelationships. New developments concerning the role of sodium/potassium ATPase, atrial natriuretic peptide, arginine vasopressin and angiotensin II as regulatory forces are outlined, together with a review of earlier work. Abnormalities found in women with, or destined for, PAH are described and their significance is discussed.