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BACKGROUND: Autosomal recessive renal tubular dysgenesis is a rare, usually fatal inherited disorder of the renin-angiotensis system (RAS). Herein, we report an adolescent individual experiencing an unknown chronic kidney disease and aim to provide novel insights into disease mechanisms. METHODS: Exome sequencing for a gene panel associated with renal disease was performed. The RAS was assessed by comprehensive biochemical analysis in blood. Renin expression was determined in primary tubular cells by quantitative polymerase chain reaction and in situ hybridization on kidney biopsy samples. Allele frequencies of heterozygous and biallelic deleterious variants were determined by analysis of the Genomics England 100,000 Genomes Project. RESULTS: The patient was delivered prematurely after oligohydramnios was detected during pregnancy. Postnatally, he recovered from third-degree acute kidney injury but developed chronic kidney disease stage G3b over time. Exome sequencing revealed a previously reported pathogenic homozygous missense variant, p.(Arg375Gln), in the AGT (angiotensinogen) gene. Blood AGT concentrations were low, but plasma renin concentration and gene expression in kidney biopsy, vascular, and tubular cells revealed strong upregulation of renin. Angiotensin II and aldosterone in blood were not abnormally elevated. CONCLUSIONS: Renal tubular dysgenesis may present as chronic kidney disease with a variable phenotype, necessitating broad genetic analysis for diagnosis. Functional analysis of the RAS in a patient with AGT mutation revealed novel insights regarding compensatory upregulation of renin in vascular and tubular cells of the kidney and in plasma in response to depletion of AGT substrate as a source of Ang II (similarly observed with hepatic AGT silencing for the treatment of hypertension). [ABSTRACT FROM AUTHOR]

BACKGROUND: Angiotensin-(1-12), measured by a self-developed, polyclonal antibody-based radioimmunoassay, has been suggested to act as an alternative precursor of angiotensin II. A more reliable detection method would be liquid chromatography-tandem mass spectrometry. METHODS: We set up the quantification of human and murine angiotensin-(1-12) by liquid chromatography-tandem mass spectrometry and then used this method to measure angiotensin-(1-12) in human, rat, and mouse blood samples, as well as in mouse brain, mouse kidney, and rat heart. We also verified ex vivo angiotensin-(1-12) generation and metabolism in human blood samples incubated at 37 °C. RESULTS: Stabilization of blood in guanidine hydrochloride was chosen for sample collection since this allowed full recovery of spiked angiotensin-(1-12). Angiotensin-(1-12) was undetectable in human blood samples when incubating nonstabilized plasma at 37 °C, while angiotensin-(1-12) added to nonstabilized human plasma disappeared within 10 minutes. Stabilized human blood samples contained angiotensin II, while angiotensin-(1-12) was undetectable. Blood, hearts, and kidneys, but not brains, of wild-type mice and rats contained detectable levels of angiotensin II, while angiotensin-(1-12) was undetectable. In renin knockout mice, all angiotensins, including angiotensin-(1-12), were undetectable at all sites, despite a 50% rise in angiotensinogen. Angiotensin-(1-12) metabolism in human blood plasma was not affected by renin inhibition. Yet, blockade of angiotensin-converting enzyme and aminopeptidase A, but not of chymase, neutral endopeptidase, or prolyl oligopeptidase, prolonged the half-life of angiotensin-(1-12), and angiotensin-converting enzyme inhibition prevented the formation of angiotensin II. CONCLUSIONS: We were unable to detect intact angiotensin-(1-12) in humans, rats, and mice, either in blood or tissue, suggesting that this metabolite is an unlikely source of endogenous angiotensins. [ABSTRACT FROM AUTHOR]

ACE (angiotensin-converting enzyme)-2 as the target for SARS-CoV-2 also negatively regulates the renin-angiotensin system. Pathological activation of ADAM17 (A disintegrin and metalloproteinase-17) may potentiate inflammation and diminish ACE2-mediated tissue protection through proteolytic shedding, contributing to SARS-CoV-2 pathogenesis. We aim to examine plasma soluble ACE2 and angiotensin profiles in relation to outcomes by enrolling consecutive patients admitted for COVID-19 with baseline blood collection at admission and repeated sampling at 7 days. The primary outcome was 90-day mortality, and secondary outcomes were the incidence of end-organ injuries. Overall, 242 patients were included, the median age was 63 (52-74) years, 155 (64.0%) were men, and 57 (23.6%) patients reached the primary end point. Baseline soluble ACE2 was elevated in COVID-19 but was not associated with disease severity or mortality. In contrast, an upward trajectory of soluble ACE2 at repeat sampling was independently associated with an elevated risk of mortality and incidence of acute myocardial injury and circulatory shock. Similarly, an increase in soluble tumor necrosis factor receptor levels was also associated with adverse outcomes. Plasma Ang I, Ang 1-7 (angiotensin 1-7) levels, and the Ang 1-7/Ang II (angiotensin II) ratio were elevated during SARS-CoV-2 infection related to downregulation of ACE activity at baseline. Moreover, patients having an upward trajectory of soluble ACE2 were characterized by an imbalance in the Ang 1-7/Ang II ratio. The observed dysregulation of ACE2 and angiotensin peptides with disease progression suggest a potential role of ADAM17 inhibition and enhancing the beneficial Ang 1-7/Mas axis to improve outcomes against SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

[Figure: see text]. [ABSTRACT FROM AUTHOR]

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The aldosterone/renin ratio (ARR) is currently considered the most reliable approach for case detection of primary aldosteronism (PA). ACE (Angiotensin-converting enzyme) inhibitors are known to raise renin and lower aldosterone levels, thereby causing false-negative ARR results. Because ACE inhibitors lower angiotensin II levels, we hypothesized that the aldosterone/equilibrium angiotensin II (eqAngII) ratio (AA2R) would remain elevated in PA. Receiver operating characteristic curve analysis involving 60 patients with PA and 40 patients without PA revealed that the AA2R was not inferior to the ARR in screening for PA. When using liquid chromatography-tandem mass spectrometry to measure plasma aldosterone concentration, the predicted optimal AA2R cutoff for PA screening was 8.3 (pmol/L)/(pmol/L). We then compared the diagnostic performance of the AA2R with the ARR among 25 patients with PA administered ramipril (5 mg/day) for 2 weeks. Compared with basally, plasma levels of equilibrium angiotensin I (eqAngI) and direct renin concentration increased significantly (P<0.01 or P<0.05) after ramipril treatment, whereas eqAngII and ACE activity (eqAngII/eqAngI) decreased significantly (P<0.01). The changes of plasma renin activity and plasma aldosterone concentration in the current study were not significant. On day 14, 4 patients displayed false-negative results using ARR_direct renin concentration (plasma aldosterone concentration/direct renin concentration), 3 of whom also showed false-negative ARR_plasma renin activity (plasma aldosterone concentration/plasma renin activity). On day 15, 2 patients still demonstrated false-negative ARR_plasma renin activity, one of whom also showed a false-negative ARR_direct renin concentration. No false-negative AA2R results were observed on either day 14 or 15. In conclusion, compared with ARR which can be affected by ACE inhibitors causing false-negative screening results, the AA2R seems to be superior in detecting PA among subjects receiving ACE inhibitors. [ABSTRACT FROM AUTHOR]

IL (Interleukin)-1 antagonism decreases blood pressure in obese individuals. The underlying mechanisms are unknown. Based on experimental data, we hypothesized an effect of IL-1 antagonism via modulation of the renin-angiotensin-aldosterone system. In this explorative study, we examined shorter- (2 days) and longer-term effects (4 weeks) of IL-1 antagonism (anakinra/Kineret) on renin-angiotensin system peptide profiles and on hemodynamic parameters assessed by noninvasive measurement in obese (body mass index ≥30 kg/m2) individuals from 2 interventional trials (a prospective interventional trial [n=73] and a placebo controlled-double blinded interventional trial [n=67]). A total of 140 patients were included. Systolic blood pressure decreased after short-term (absolute difference -5.2 mm Hg [95% CI, -8.5 to -1.8]; P=0.0006) and after longer-term treatment with anakinra (absolute difference -3.9 mm Hg [95% CI, -7.59 to -0.21]; P=0.04), with no change in blood pressure in the placebo group. Upon IL-1 antagonism, equilibrium levels of Ang II (angiotensin II), Ang I, aldosterone, and renin remained unchanged. In contrast, Ang (1-7) peptide levels increased after 4 weeks (between-group difference 16.35 pmol/L [95% CI, 1.22-30.17], P=0.03), as well as the Ang (1-7)/Ang II ratio (between-group difference 0.42 [95% CI, 0.17-0.67], P=0.02) in comparison to placebo. Consistently, the stroke systemic vascular resistance index significantly decreased in the anakinra group (between-group difference of -62.65 dyn/sec per cm-5 per m2 [95% CI, -116.94 to -18.36], P=0.008, consistent with a 25% decrease). IL-1 antagonism increased the vasodilatory Ang (1-7) peptide after 4 weeks of treatment in obese individuals, paralleled by a decrease in peripheral vascular resistance. These findings point to an IL-1 mediated blood pressure-lowering mechanism via modulation of Ang (1-7). Registration- URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02227420 and NCT02672592. [ABSTRACT FROM AUTHOR]

Primary aldosteronism is recognized as the most frequent cause of secondary hypertension, and its screening is expected to become a routine evaluation in most patients with hypertension. The interference of antihypertensive therapies with the aldosterone-to-renin ratio during screening process is a major confounder. Renin-angiotensin-aldosterone system Triple-A analysis is a novel liquid chromatography/tandem mass spectrometry diagnostic assay that allows simultaneous quantification of aldosterone, equilibrium Ang I (angiotensin I), and Equilibrium Ang II in a single sample of serum. We performed a comparative evaluation of the diagnostic performance of the aldosterone-to-Ang II ratio and 5 renin-based diagnostic ratios, differing in methods to determine aldosterone levels and renin activity in a cohort of 110 patients with hypertension (33 patients with confirmed primary aldosteronism and 77 with essential hypertension). All ratios showed comparable areas under the curves ranging between 0.924 and 0.970 without significant differences between each other. The evaluation of the Ang II-to-Ang I ratio revealed persistent drug intake in some patients as cause for suppressed renin-based diagnostic ratios, while aldosterone-to-Ang II ratio remained unaffected. The Youden index optimal cutoff value for the aldosterone-to-Ang II ratio was 6.6 ([pmol/L]/[pmol/L]) with a sensitivity of 90% and a specificity of 93%, proving noninferiority compared with the aldosterone-to-renin ratio while pointing to the potential for an interference-free application in patients under ACE (angiotensin-converting enzyme) inhibitor therapy. This study shows for the first time the accuracy and reliability of renin-angiotensin-aldosterone system triple-A analysis for the screening of primary aldosteronism that can be applied in clinical routine. [ABSTRACT FROM AUTHOR]

The renin-angiotensin system plays an important role in the development and progression of heart failure (HF). In addition to the classical renin-angiotensin pathway, an alternative pathway produces Angs (angiotensins), which counteract the negative effects of Ang II. We hypothesized that Ang profiling could provide insights into the pathogenesis and prognosis of HF with preserved ejection fraction. We aimed to investigate the effects of Angs on outcome in HF with preserved ejection fraction. Consecutive patients were included into a prospective single-center registry. Clinical, laboratory, and imaging parameters were assessed and serum samples were taken at baseline and measured by mass spectroscopy. Serum equilibrium levels were analyzed in regard to the combined clinical end point of cardiovascular death or HF hospitalization. In total, 155 patients were included during a median follow-up time of 22.5 (interquartile range, 4.0-61.0) months, 52 individuals (34%) reached the combined end point. We identified higher levels of Ang 1-7 and Ang 1-5 as predictors for poor outcome. After adjusting for potential confounding factors, Ang 1-5 remained predictive for poor outcome. In addition to Ang 1-7 and Ang 1-5, the novel ACE (angiotensin-converting enzyme) independent Ang composite marker [Ang 1-7+Ang 1-5] was shown to predict adverse events. We conclude that Angs of the alternative renin-angiotensin system seem to play a role in HF with preserved ejection fraction and are linked to outcome in patients with HF and preserved ejection fraction. Ang 1-5 and the alternative renin-angiotensin system composite marker [Ang 1-7+Ang 1-5] are independent predictors of outcome. [ABSTRACT FROM AUTHOR]

Small interfering RNAs (siRNAs) targeting hepatic angiotensinogen ( Agt) may provide long-lasting antihypertensive effects, but the optimal approach remains unclear. Here, we assessed the efficacy of a novel AGT siRNA in spontaneously hypertensive rats. Rats were treated with vehicle, siRNA (10 mg/kg fortnightly; subcutaneous), valsartan (31 mg/kg per day; oral), captopril (100 mg/kg per day; oral), valsartan+siRNA, or captopril+valsartan for 4 weeks (all groups, n=8). Mean arterial pressure (recorded via radiotelemetry) was lowered the most by valsartan+siRNA (-68±4 mm Hg), followed by captopril+valsartan (-54±4 mm Hg), captopril (-23±2 mm Hg), siRNA (-14±2 mm Hg), and valsartan (-10±2 mm Hg). siRNA and captopril monotherapies improved cardiac hypertrophy equally, but less than the dual therapies, which also lowered NT-proBNP (N-terminal pro-B-type natriuretic peptide). Glomerular filtration rate, urinary NGAL (neutrophil gelatinase-associated lipocalin), and albuminuria were unaffected by treatment. siRNA lowered circulating AGT by 97.9±1.0%, and by 99.8±0.1% in combination with valsartan. Although siRNA greatly reduced renal Ang (angiotensin) I, only valsartan+siRNA suppressed circulating and renal Ang II. This coincided with decreased renal sodium hydrogen exchanger type 3 and phosphorylated sodium chloride cotransporter abundances. Renin and plasma K+ increased with every treatment, but especially during valsartan+siRNA; no effects on aldosterone were observed. Collectively, these data indicate that Ang II elimination requires >99% suppression of circulating AGT. Maximal blockade of the renin-angiotensin system, achieved by valsartan+siRNA, yielded the greatest reduction in blood pressure and cardiac hypertrophy, whereas AGT lowering alone was as effective as conventional renin-angiotensin system inhibitors. Given its stable and sustained efficacy, lasting weeks, RNA interference may offer a unique approach to improving therapy adherence and treating hypertension. [ABSTRACT FROM AUTHOR]

Because of the presence of the blood-brain barrier, brain renin-angiotensin system activity should depend on local (pro)renin synthesis. Indeed, an intracellular form of renin has been described in the brain, but whether it displays angiotensin (Ang) I-generating activity (AGA) is unknown. Here, we quantified brain (pro)renin, before and after buffer perfusion of the brain, in wild-type mice, renin knockout mice, deoxycorticosterone acetate salt-treated mice, and Ang II-infused mice. Brain regions were homogenized and incubated with excess angiotensinogen to detect AGA, before and after prorenin activation, using a renin inhibitor to correct for nonrenin-mediated AGA. Renin-dependent AGA was readily detectable in brain regions, the highest AGA being present in brain stem (>thalamus=cerebellum=striatum=midbrain>hippocampus=cortex). Brain AGA increased marginally after prorenin activation, suggesting that brain prorenin is low. Buffer perfusion reduced AGA in all brain areas by >60%. Plasma renin (per mL) was 40× to 800× higher than brain renin (per gram). Renin was undetectable in plasma and brain of renin knockout mice. Deoxycorticosterone acetate salt and Ang II suppressed plasma renin and brain renin in parallel, without upregulating brain prorenin. Finally, Ang I was undetectable in brains of spontaneously hypertensive rats, while their brain/plasma Ang II concentration ratio decreased by 80% after Ang II type 1 receptor blockade. In conclusion, brain renin levels (per gram) correspond with the amount of renin present in 1 to 20 μL of plasma. Brain renin disappears after buffer perfusion and varies in association with plasma renin. This indicates that brain renin represents trapped plasma renin. Brain Ang II represents Ang II taken up from blood rather than locally synthesized Ang II. [ABSTRACT FROM AUTHOR]

A newly produced murine recombinant angiotensin (Ang)-converting enzyme 2 (ACE2) was characterized in vivo and in vitro. The effects of available ACE2 inhibitors (MLN-4760 and 2 conformational variants of DX600, linear and cyclic) were also examined. When murine ACE2 was given to mice for 4 weeks, a marked increase in serum ACE2 activity was sustainable. In acute studies, mouse ACE2 (1 mg/kg) obliterated hypertension induced by Ang II infusion by rapidly decreasing plasma Ang II. These effects were blocked by MLN-4760 but not by either form of DX600. In vitro, conversion from Ang II to Ang-(1-7) by mouse ACE2 was blocked by MLN-4760 (10(-6) m) but not by either form of DX600 (10(-5) m). Quantitative analysis of multiple Ang peptides in plasma ex vivo revealed formation of Ang-(1-9) from Ang I by human but not by mouse ACE2. Both human and mouse ACE2 led to the dissipation of Ang II with formation of Ang (1-7). By contrast, mouse ACE2-driven Ang-(1-7) formation from Ang II was blocked by MLN-4760 but not by either linear or cyclic DX600. In conclusion, sustained elevations in serum ACE2 activity can be accomplished with murine ACE2 administration, thereby providing a strategy for ACE2 amplification in chronic studies using rodent models of hypertension and cardiovascular disease. Human but not mouse ACE2 degrades Ang I to form Ang-(1-9). There are also species differences regarding rodent and human ACE2 inhibition by known inhibitors such that MLN-4760 inhibits both human and mouse ACE2, whereas DX600 only blocks human ACE2 activity. [ABSTRACT FROM AUTHOR]

This article discusses a study which examined the characteristics of a newly produced murine recombinant angiotensin-converting enzyme 2 (ACE2) in vivo and in vitro and the effects of its inhibitors. Researchers discovered that sustained elevations in serum ACE2 activity can be accomplished with murine ACE2 administration. They also learned that there are species differences regarding rodent and human ACE2 inhibition by known inhibitors.

Fluid balance, salt retention and tissue remodeling is hormonally regulated by the Renin-Angiotensin-System. The sophisticated enzyme network serially cleaves peptide hormones generating various effector hormones including the vasoconstrictor Angiotensin 1-8 and its counterbalancing downstream metabolite Angiotensin 1-7.LC-MS/MS based analysis of kidney and plasma of ACE2 knockout mice revealed unchanged Angiotensin 1-7 concentrations compared to wild type animals pointing to alternative pathways of Angiotensin 1-7 formation and suggesting a minor role for ACE2 in the formation of Angiotensin 1-7 in vivo. Moreover, we observed a decrease in the Angiotensin 1-8/Angiotensin 1-10 ratio in ACE2KO-mice indicating a changed conversion rate from Angiotensin 1-10 to Angiotensin 1-8.We analyzed Angiotensin 1-7 metabolism in kidney homogenates by spiking natural substrates in the absence and presence of specific enzyme inhibitors. The metabolism of ex vivo spiked Angiotensins in kidney homogenates in presence and absence of the Prolyl-Carboxypepdidase (PCP) and Prolyl-Endopeptidase (PEP) Inhibitor ZPP and the ACE2-Inhibitor MLN-4760 revealed stronger contribution of PCP and PEP to Angiotensin 1-7 formation than ACE2.Analyzing the formation of Angiotensin 1-8 from Angiotensin 1-10 in renal cortex and medulla homogenates of WT and ACE2KO mice in the absence and presence of an ACE-Inhibitor confirmed our observations on endogenous peptide levels and the ratio between Angiotensin 1-8 and Angiotensin 1-10 in plasma, revealing a reduced ACE activity in the renal cortex of ACE2KO.Our study raises questions concerning the relevance of renal ACE2 for the local formation of Angiotensin 1-7. Moreover, the reduced ACE expression and activity in renal cortex might be a physiologically and therefore phenotype relevant consequence of the knockdown of ACE2 in these mice. The possible crosstalk between ACE and ACE2 expression and activity might give rise to further studies addressing the underlying mechanisms and might be important for our understanding of RAS dynamics in regard to therapeutic interventions. [ABSTRACT FROM AUTHOR]

ACE2 (Angiotensin Converting Enzyme type 2) is involved in the conversion of the vasoconstrictor peptide Angiotensin (Ang)-II into its vasodilatory metabolite Ang-(1-7), thereby offering a new perspective for the treatment of cardiovascular diseases associated with over-activity of the renin-angiotensin system. Our group recently reported that ACE2 shedding, a process by which ACE2 is cleaved from the plasma membrane and secreted into the surrounding milieu, contributes to the loss of the enzyme’s compensatory activity in the central nervous system (CNS) during the development of experimental hypertension. The objective of this study was to determine whether ACE2 shedding is taking place in the CNS of patients during hypertension. Unused cerebrospinal fluid, collected from patients (17 males and 27 females, aged 22-66) for diagnostic purposes, was divided in 3 groups: normotensive (n=23), hypertensive (n=9), and hypertensive controlled with medication (n=12). In addition, blood pressure values and current medications were recorded. While ELISA lacked sensitivity, soluble levels of hACE2 (sACE2) could be detected by Mass spectrometry-based RAS-Fingerprint™ in all patients. Validation experiments (n=16) indicated that pre-treatment with MLN4760 (ACE2 inhibitor) abolished the conversion of Ang-II to Ang-(1-7) by 76 ±3 %, suggesting that ACE2 is the main enzyme converting Ang-II to Ang-(1-7) in human CSF. In hypertensive patients not taking blood pressure medications, (Systolic: 157 ±10, Diastolic: 95 ±7 mmHg; n=6) CSF sACE2 activity was significantly higher (21.7 ±8.3 AU; P<0.05) than in normotensive (Systolic: 114 ±4, Diastolic: 75 ±4 mmHg; n=15) patients (6.6 ±0.9 AU). However, in patients with controlled hypertension (Systolic: 129 ±6, Diastolic: 86 ±5 mmHg; n=5), CSF sACE2 levels were normalized (6.9 ±1.9 AU). Comparison of systolic or diastolic blood pressure vs. sACE2 activity levels showed no significant correlation. These data suggest that ACE2 shedding is taking place in the CNS of hypertensive patients. Soluble ACE2 activity in the CSF is correlated with high blood pressure and could be used as a biomarker of neurogenic hypertension. AU: arbitrary unit. [ABSTRACT FROM AUTHOR]

The Renin-Angiotensin-System is a peptide hormone cascade being responsible for the regulation of blood pressure and fluid balance through a sophisticated signaling network. During recent years the local Renin-Angiotensin-System (RAS) moved increasingly into the focus of research as the expression of multiple angiotensin processing enzymes had been reported for tissues. Nevertheless, scientific progress in this field is hampered due to the obvious presence of technical caveats in the analysis of the local RAS, which are indicated by a tremendous variation of tissue angiotensin levels reported in the literature. Hence, in order to assess the functions of the local RAS in different tissues, a solid and reproducible assay for the measurement of endogenous angiotensin peptide levels in tissues would be essential. We developed a novel mass-spectrometry-based method allowing the quantification of up to 10 angiotensin metabolites in tissue samples simultaneously. This novel tool was tested for applicability in murine studies by measuring tissue and plasma levels of angiotensin metabolites in wildtype and ACE2 knockout mice treated with various RAS-interfering drugs. The study provided deep insights into the systemic and tissue specific RAS revealing drug specific responses. As expected, the knockout of ACE2 resulted in increased Angiotensin II levels in hearts of knockout animals while the kidneys were only moderately affected. Enalapril treatment significantly lowered Angiotensin II levels in all investigated tissues. Surprising tissue specific effects were observed regarding other angiotensin metabolites, which underlines the importance of the comprehensive analysis of the RAS for conclusive interpretation of pharmacologic studies and allows to draw conclusions about expression levels of RAS-enzymes in the tissue of interest. Mass spectrometry based multiplex quantification of tissue angiotensin peptides (Tissue RAS-Fingerprinting) is a potent analytic tool for applications in basic science and drug development. Multiplex analysis of the tissue RAS provides new insights that might lead to the development of novel drugs and therapeutic concepts for the treatment of cardiovascular diseases in the future. [ABSTRACT FROM AUTHOR]

Angiotensin concentrations are affected by multiple molecular components including receptors and enzymes which might be either dissolved in plasma or attached to blood cells or endothelial surfaces throughout the body, giving rise to a concentration determining local enzymatic environment. This environment substantially changes during blood collection leading to a rapid and fundamental shift in angiotensin peptide levels. Therefore, a clearly defined and properly controlled sample stabilization procedure is essential for the accurate measurement of in vivo angiotensin peptide levels.Surprisingly, standard samples collected by anti-coagulation with heparin can be used for analyzing the human RAS under well-defined steady-state conditions, allowing RAS-Fingerprint based conclusions about the activities of circulating enzymes involved in angiotensin metabolism. The mass spectrometry based measurements of in vivo RAS-Fingerprints (immediate sample stabilization) or heparin plasma derived ex vivo RAS-Fingerprints in plasma or whole blood provide unique insights into the physiology of the human RAS. RAS-Fingerprinting provides an integrated view about the activity of the enzymes involved in angiotensin metabolism in a plasma sample and therefore represents a powerful tool for characterization of the patient specific “Biochemical Hardware”, which determines angiotensin peptide levels in vivo.The assay is compatible with undiluted plasma and whole blood and can be further applied to long-term stored frozen plasma samples. The utilization of RAS-Fingerprinting in clinical studies will substantially enhance our understanding of the human RAS and could lead to the development of personalized approaches for the treatment and prevention of cardiovascular diseases in the near future. [ABSTRACT FROM AUTHOR]

There are species differences between the currently used ACE2 inhibitors (MLN-4760 and DX600) that could be critically relevant to the proper interpretation of studies with these compounds. The effect of these inhibitors on ACE2-driven angiotensin peptides formation and degradation has not yet been studied. Accordingly, we examined the ability of MLN-4760 and two conformational variants of DX600 [a linear (L) and a cyclic (C) form] to inhibit human (h) and mouse (m) recombinant (r) ACE2 using a novel ex vivo LC-MS/MS based approach to concomitantly measure several peptides within the RAS system in plasma. Both mrACE2 and hrACE2 (5ug/mL) when added to blood plasma caused a complete disappearance of Ang II and lead to the formation of Ang-(1-7). As a result of the increase in Ang-(1-7) formation, both mrACE2 and hrACE2 lead also to the formation of Ang-(1-5). This reaction was likely driven by ACE which, like other peptidases, is present in plasma ex vivo assay. The effects of hrACE2 and mrACE2 on the above mentioned Ang peptides were inhibited by MLN-4760 at 10-5M and also at lower concentrations (10-6M and 10-7M). Both, L-DX600 and C-DX600 inhibited the effect of hrACE2 on Ang-(1-7) and Ang-(1-5) formation and this effect was also dose-dependent. By contrast, neither L-DX600 nor C-DX600, even at a high concentration (10-5M), prevented the changes on Ang peptides effected by mrACE2. hrACE2 decreased Ang I levels by 60% whereas mrACE2 did it only marginally. Of note, hrACE2 resulted in the formation of Ang-(1-9) from Ang I whereas mrACE2 did not. In conclusion, there are major differences between the known specific inhibitors of ACE2 between hrACE2 and mrACE2. MLN-4760 inhibits both hrACE2 and mrACE2 whereas DX600 inhibits hrACE2 preferentially. DX600 does not prevent mrACE2-driven formation of Ang-(1-7) from Ang II. mrACE2 effectively degrades Ang II forming Ang-(1-7) whereas it has no effect on the formation of Ang-(1-9) from Ang I. RAS “fingerprinting” is a powerful novel approach to simultaneously evaluate quantitatively several angiotensin peptides in plasma and can be used to demonstrate profound differences on the effect of available ACE2 inhibitors on the formation of various angiotensin peptides driven by human and mouse ACE2. [ABSTRACT FROM AUTHOR]

The Renin-Angiotensin-System (RAS) is critically involved in the regulation of important physiological functions including blood pressure and fluid balance. It is constituted by multiple enzymes giving rise to a meshwork of effector peptides, which mediate their functions through binding to specific receptor molecules. Therefore, the modification of angiotensin peptide levels represents a common strategy for the treatment of RAS-associated diseases and is frequently achieved by the pharmacologic regulation of enzymes taking part in angiotensin metabolism. We developed a highly sensitive method, which allows the simultaneous absolute quantification of up to 10 different angiotensin peptides in human plasma and whole blood (RAS-Fingerprinting). The measurement of RAS-Fingerprints provides unique insights into the physiology of the human RAS and therefore represents a powerful tool for the patient specific evaluation of this physiologically important peptide hormone system. Beside the precise quantification of angiotensin peptides in plasma and whole blood, RAS-Fingerprints analyze the biochemical hardware of the RAS at a previously unachieved level of detail and accuracy. During the development and validation of our LC-MS/MS based method, comprehensive datasets showing multiple applications for RAS-Fingerprinting have been generated. Investigation of healthy volunteers revealed that a patient specific state of the RAS exists, which is defined by a unique composition of RAS enzyme activities that might have crucial effects on the outcome of RAS targeted therapies in individual patients. RAS-Fingerprinting in healthy volunteers treated with an Angiotensin-Receptor-Blockers, ACE-Inhibitor or Renin-Inhibitor revealed that the human RAS reacts to different drugs in a very dynamic and specific way. Therefore, RAS-Fingerprinting could contribute to the development of innovative therapeutic approaches affecting the RAS. The implementation of RAS-Fingerprinting into clinical studies would substantially enhance our understanding of the human RAS and could lead to the development of personalized treatment schemes in the management of RAS-associated diseases in the near future. [ABSTRACT FROM AUTHOR]