Renin–Angiotensin–Aldosterone System and Immunomodulation: A State-of-the-Art Review
Open accessAbstract
The renin–angiotensin system (RAS) has long been described in the field of cardiovascular physiology as the main player in blood pressure homeostasis. However, other effects have since been described, and include proliferation, fibrosis, and inflammation. To illustrate the immunomodulatory properties of the RAS, we chose three distinct fields in which RAS may play a critical role and be the subject of specific treatments. In oncology, RAS hyperactivation has been associated with tumor migration, survival, cell proliferation, and angiogenesis; preliminary data showed promise of the benefit of RAS blockers in patients treated for certain types of cancer. In intensive care medicine, vasoplegic shock has been associated with severe macro- and microcirculatory imbalance. A relative insufficiency in angiotensin II (AngII) was associated to lethal outcomes and synthetic AngII has been suggested as a specific treatment in these cases. Finally, in solid organ transplantation, both AngI and AngII have been associated with increased rejection events, with a regional specificity in the RAS activity. These elements emphasize the complexity of the direct and indirect interactions of RAS with immunomodulatory pathways and warrant further research in the field.
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The ACE-Ang II-AT1/2R and ACE2-Ang(1-7)-MasR pathways restrict each other and jointly maintain the relative stability of the internal environment.
“Up till now, two key polypeptides in RAS as well as their enzymes and receptors constitute two core pathways in this system, ACE-Ang II-AT1/2R and ACE2-Ang(1–7)-MasR, which restrict each other and jointly maintain the relative stability of the internal environment [28–30].”
From Transplantation of human umbilical cord-derived mesenchymal stem cells improves age-related ovarian functional decline via regulating the local renin–angiotensin system on inflammation and oxidative stress (2024) · cites this paper as [29]
Section 2.1 (page not provided) describes ACE2–Ang(1–7)–Mas as counter-regulatory to Ang II and links these pathways to blood-pressure and salt-balance regulation. But sections 2.1 and 2.3 distinguish AT2R from AT1R: AT2R can antagonize AT1R, so the paper does not treat the combined AT1/2R pathway as uniformly opposed to Mas. It also does not state that the two pathways jointly maintain the stability of the internal environment. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAng(1-7) counteracts the overactivated Ang II axis.
“In particular, we should not ignore the counteracting effect of Ang(1–7) on the overactivated Ang II axis [28–30].”
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- Authors
- Laghlam, D., Jozwiak, M., & Nguyen, L. S.
- Affiliations
- Clinique Ambroise Paré (FR)
- Corresponding author
- Nguyen, Lee S.
- Venue
- Cells
- Publisher
- MDPI AG
- Published
- 2021-07-13
- Volume
- 10
- Issue
- 7
- Pages
- 1767
- ISSN
- 2073-4409 (ISSN-L)
- PMC
- PMC8303450
- OpenAlex
- W3178389255
- Cited by
- 96
- References
- 4
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 27 · 2023: 28 · 2022: 12 · 2021: 2
- FWCI
- 3.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Cells (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Genetics › Coagulation, Bradykinin, Polyphosphates, and Angioedema
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Eicosanoids and Hypertension Pharmacology
- Keywords
- renin-angiotensin system, immunomodulation, angiotensin II, angiotensin I, cancer, tumor angiogenesis, vasoplegic shock, organ rejection, solid organ transplantation, inflammation, fibrosis, blood pressure homeostasis
- MeSH terms
- Animals, Humans, Intensive Care Units, Neoplasms, Renin-Angiotensin System, Transplantation, Signal Transduction, Immunomodulation
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