Role of renin-angiotensin-aldosterone system in adipose tissue dysfunction

The renin-angiotensin-aldosterone system (RAAS) is known to be closely linked to the pathogenesis of insulin resistance. The angiotensin (Ang) II type 1 (AT₁) receptor mediates the major effects of Ang II in adipose tissue, and blockade of the AT₁ receptor improves insulin sensitivity, with enhanced adipocyte differentiation. In contrast, the role of angiotensin type 2 (AT₂) receptor activation in insulin sensitivity is still controversial, although AT₂ receptor functions are thought to be mutually antagonistic against those of the AT₁ receptor in the cardiovascular system. Aldosterone exerts its biological roles via the mineralocorticoid receptor (MR), and inhibition of MR signaling in adipose tissue ameliorates inflammation, with upregulation of insulin-mediated glucose transport and adipocyte differentiation. Clinical studies indicate that blockade of RAAS prevents the new onset of type 2 diabetes and improves the metabolic syndrome in diabetic patients. We here review the recent concepts of the roles of RAAS in adipose tissue.