ACE2/Ang-(1-7) signaling and vascular remodeling

The renin-angiotensin system (RAS) regulates vascular tone and plays a critical role in vascular remodeling, which is the result of a complex interplay of alterations in vascular tone and structure. Inhibition of the RAS has led to important pharmacological tools to prevent and treat vascular diseases such as hypertension, diabetic vasculopathy and atherosclerosis. Angiotensin converting enzyme 2 (ACE2) was recently identified as a multifunctional monocarboxypeptidase responsible for the conversion of angiotensin (Ang) II to Ang-(1-7). The ACE2/Ang-(1-7) signaling has been shown to prevent cellular proliferation, pathological hypertrophy, oxidative stress and vascular fibrosis. Thus, the ACE2/Ang-(1-7) signaling is deemed to be beneficial to the cardiovascular system as a negative regulator of the RAS. The addition of the ACE2/Ang-(1-7) signaling to the complexities of the RAS may lead to the development of novel therapeutics for the treatment of hypertension and other vascular diseases. The present review considers recent findings regarding the ACE2/Ang-(1-7) signaling and focuses on its regulatory roles in processes related to proliferation, inflammation, vascular fibrosis and remodeling, providing proof of principle for the potential use of ACE2 as a novel therapy for vascular disorders related to vascular remodeling.