Angiotensin II AT(1) receptor blockers as treatments for inflammatory brain disorders

Clin Sci (Lond). 2012 Nov;123(10):567-90. doi: 10.1042/CS20120078.

Abstract

The effects of brain AngII (angiotensin II) depend on AT(1) receptor (AngII type 1 receptor) stimulation and include regulation of cerebrovascular flow, autonomic and hormonal systems, stress, innate immune response and behaviour. Excessive brain AT(1) receptor activity associates with hypertension and heart failure, brain ischaemia, abnormal stress responses, blood-brain barrier breakdown and inflammation. These are risk factors leading to neuronal injury, the incidence and progression of neurodegerative, mood and traumatic brain disorders, and cognitive decline. In rodents, ARBs (AT(1) receptor blockers) ameliorate stress-induced disorders, anxiety and depression, protect cerebral blood flow during stroke, decrease brain inflammation and amyloid-β neurotoxicity and reduce traumatic brain injury. Direct anti-inflammatory protective effects, demonstrated in cultured microglia, cerebrovascular endothelial cells, neurons and human circulating monocytes, may result not only in AT(1) receptor blockade, but also from PPARγ (peroxisome-proliferator-activated receptor γ) stimulation. Controlled clinical studies indicate that ARBs protect cognition after stroke and during aging, and cohort analyses reveal that these compounds significantly reduce the incidence and progression of Alzheimer's disease. ARBs are commonly used for the therapy of hypertension, diabetes and stroke, but have not been studied in the context of neurodegenerative, mood or traumatic brain disorders, conditions lacking effective therapy. These compounds are well-tolerated pleiotropic neuroprotective agents with additional beneficial cardiovascular and metabolic profiles, and their use in central nervous system disorders offers a novel therapeutic approach of immediate translational value. ARBs should be tested for the prevention and therapy of neurodegenerative disorders, in particular Alzheimer's disease, affective disorders, such as co-morbid cardiovascular disease and depression, and traumatic brain injury.

Publication types

  • Research Support, N.I.H., Intramural
  • Review

MeSH terms

  • Aging / drug effects
  • Angiotensin II / metabolism
  • Angiotensin II Type 1 Receptor Blockers / pharmacology
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Biomarkers / metabolism
  • Brain / blood supply
  • Brain / drug effects
  • Brain / metabolism
  • Brain / physiopathology
  • Brain Diseases / drug therapy*
  • Brain Diseases / etiology
  • Brain Diseases / prevention & control
  • Brain Injuries / drug therapy
  • Brain Injuries / etiology
  • Brain Injuries / prevention & control
  • Brain Ischemia / complications
  • Brain Ischemia / drug therapy
  • Brain Ischemia / prevention & control
  • Humans
  • Inflammation / drug therapy
  • Inflammation / metabolism
  • Inflammation / physiopathology
  • Mood Disorders / drug therapy
  • Mood Disorders / etiology
  • Mood Disorders / prevention & control
  • Neurodegenerative Diseases / drug therapy
  • Neurodegenerative Diseases / etiology
  • Neurodegenerative Diseases / prevention & control
  • Neuroprotective Agents / pharmacology
  • Neuroprotective Agents / therapeutic use*
  • Receptor, Angiotensin, Type 1 / metabolism
  • Renin-Angiotensin System / drug effects
  • Renin-Angiotensin System / physiology
  • Risk Factors
  • Stress, Physiological
  • Stroke / complications
  • Stroke / drug therapy
  • Stroke / prevention & control

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Biomarkers
  • Neuroprotective Agents
  • Receptor, Angiotensin, Type 1
  • Angiotensin II