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Renin-angiotensin system blockade: Its contribution and controversy
Akira Miyajima1, Takeo Kosaka1, Eiji Kikuchi1
1Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Summary
Renin-angiotensin system blockade effectively treats inflammatory diseases but its role in cancer is debated. Recent findings suggest potential increased cancer incidence, highlighting ongoing controversies and unresolved issues.
Area of Science:
- Cardiovascular Research
- Oncology
- Nephrology
Background:
- Angiotensin II, a key peptide in the renin-angiotensin system, regulates blood pressure and renal hemodynamics.
- Angiotensin II promotes fibrotic changes and neovascularization in inflammatory diseases.
- Renin-angiotensin system (RAS) blockade is established for inflammatory nephritis, cardiovascular disorders, and retinopathy.
Purpose of the Study:
- To review the contributions of the renin-angiotensin system (RAS) in disease.
- To discuss the controversies surrounding RAS blockade, particularly its dual role in inflammation and cancer.
- To provide an updated perspective on the RAS in experimental and clinical contexts.
Main Methods:
- Literature review of experimental studies on angiotensin II and renin-angiotensin system blockade.
- Analysis of clinical data and meta-analyses regarding RAS blockade efficacy and side effects.
- Discussion of proposed mechanisms for both therapeutic and potentially adverse effects of RAS blockade.
Main Results:
- RAS blockade is beneficial in inflammatory conditions like nephritis, cardiovascular diseases, and retinopathy.
- RAS blockade has demonstrated potential antitumor effects, inhibiting cancer growth, angiogenesis, and metastasis.
- A recent meta-analysis indicates a potential increase in cancer incidence with RAS blockade use, creating controversy.
Conclusions:
- The renin-angiotensin system has significantly impacted experimental models and clinical practice.
- Controversies exist regarding the use of renin-angiotensin system blockade, especially concerning cancer risk.
- Further research is needed to resolve outstanding issues and clarify the complex role of the renin-angiotensin system.
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