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Beneficial Effects of Combined AT1 Receptor/Neprilysin Inhibition (ARNI) Versus AT1 Receptor Blockade Alone in the Diabetic Eye.

Abstract Dysfunction of the renin-angiotensin system (RAS) contributes to pathogenesis of diabetic retinopathy (DR). Yet RAS blockers have only limited beneficial effects on progression of DR in clinical trials. The natriuretic peptide system offsets RAS, so that enhancing the activity of this system on top of RAS blockade might be beneficial. Neprilysin has an important role in the degradation of natriuretic peptides. Therefore, we hypothesize that dual angiotensin receptor-neprilysin inhibition (ARNI) may outperform angiotensin receptor blocker (ARB) in protection against DR. We tested this hypothesis in streptozotocin-induced diabetic transgenic (mRen2)27 rats.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title investigative ophthalmology & visual science
Publication Year Start




PMID- 27951594
OWN - NLM
STAT- In-Data-Review
DA  - 20161212
LR  - 20161217
IS  - 1552-5783 (Electronic)
IS  - 0146-0404 (Linking)
VI  - 57
IP  - 15
DP  - 2016 Dec 01
TI  - Beneficial Effects of Combined AT1 Receptor/Neprilysin Inhibition (ARNI) Versus
      AT1 Receptor Blockade Alone in the Diabetic Eye.
PG  - 6722-6730
LID - 10.1167/iovs.16-20289 [doi]
AB  - Purpose: Dysfunction of the renin-angiotensin system (RAS) contributes to
      pathogenesis of diabetic retinopathy (DR). Yet RAS blockers have only limited
      beneficial effects on progression of DR in clinical trials. The natriuretic
      peptide system offsets RAS, so that enhancing the activity of this system on top 
      of RAS blockade might be beneficial. Neprilysin has an important role in the
      degradation of natriuretic peptides. Therefore, we hypothesize that dual
      angiotensin receptor-neprilysin inhibition (ARNI) may outperform angiotensin
      receptor blocker (ARB) in protection against DR. We tested this hypothesis in
      streptozotocin-induced diabetic transgenic (mRen2)27 rats. Methods: Adult male
      diabetic (mRen2)27 rats were followed for 5 or 12 weeks. Treatment with vehicle, 
      irbesartan (ARB), or ARB combined with the neprilysin inhibitor thiorphan
      (irbesartan+thiorphan [ARNI]) occurred during the final 3 weeks. Retinal cell
      death, gliosis, and capillary loss were evaluated. Real-time polymerase chain
      reaction (RT-PCR) analyses were performed to quantify the retinal level of
      inflammatory cell markers. Results: Both ARB- and ARNI-treated groups showed
      similarly reduced retinal apoptotic cell death, gliosis, and capillary loss
      compared to the vehicle-treated group in the 5-week study. Treatment with ARNI
      reduced the expression of inflammatory markers more than ARB treatment in the
      5-week study. In the 12-week study, ARNI treatment showed significantly more
      reduction in apoptotic cell death (51% vs. 25% reduction), and capillary loss
      (68% vs. 43% reduction) than ARB treatment. Conclusions: Treatment with ARNI
      provides better protection against DR in diabetic (mRen2)27 transgenic rats,
      compared to ARB alone. This approach may be a promising treatment option for
      patients with DR.
FAU - Prasad, Tuhina
AU  - Prasad T
AD  - Department of Ophthalmology, College of Medicine, University of Florida,
      Gainesville, Florida, United States.
FAU - Roksnoer, Lodi C W
AU  - Roksnoer LC
AD  - Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, 
      Erasmus MC, Rotterdam, The Netherlands.
FAU - Zhu, Ping
AU  - Zhu P
AD  - Department of Ophthalmology, College of Medicine, University of Florida,
      Gainesville, Florida, United States.
FAU - Verma, Amrisha
AU  - Verma A
AD  - Department of Ophthalmology, College of Medicine, University of Florida,
      Gainesville, Florida, United States.
FAU - Li, Yiming
AU  - Li Y
AD  - Department of Ophthalmology, College of Medicine, University of Florida,
      Gainesville, Florida, United States.
FAU - Batenburg, Wendy W
AU  - Batenburg WW
AD  - Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, 
      Erasmus MC, Rotterdam, The Netherlands.
FAU - de Vries, Rene
AU  - de Vries R
AD  - Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, 
      Erasmus MC, Rotterdam, The Netherlands.
FAU - Danser, A H Jan
AU  - Danser AH
AD  - Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, 
      Erasmus MC, Rotterdam, The Netherlands.
FAU - Li, Qiuhong
AU  - Li Q
AD  - Department of Ophthalmology, College of Medicine, University of Florida,
      Gainesville, Florida, United States.
LA  - eng
GR  - R01 EY021752/EY/NEI NIH HHS/United States
GR  - R01 EY024564/EY/NEI NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Invest Ophthalmol Vis Sci
JT  - Investigative ophthalmology & visual science
JID - 7703701
PMC - PMC5156511
EDAT- 2016/12/13 06:00
MHDA- 2016/12/13 06:00
CRDT- 2016/12/13 06:00
AID - 2593356 [pii]
AID - 10.1167/iovs.16-20289 [doi]
PST - ppublish
SO  - Invest Ophthalmol Vis Sci. 2016 Dec 1;57(15):6722-6730. doi:
      10.1167/iovs.16-20289.

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