What is the clinical evidence from this study?

Study design: Other. Population: Atherosclerosis and lipid-induced nephropathy. Intervention: Candesartan vs. Normal-dose candesartan / 0 mg/kg/d. Primary outcome: Regression of atherosclerotic plaques in the aorta and lipid-induced nephropathy.

January 1, 2012Open Access

Regression of Atherosclerosis in Apolipoprotein E-Deficient Mice is Feasible Using High-Dose Angiotensin Receptor Blocker, Candesartan

KHKaori HayashiKeio University HSHiroyuki SasamuraKeio University TATatsuhiko AzegamiKeio University

Key Result

High-dose candesartan caused clear regression of established atherosclerotic plaques and lipid-induced nephropathy in ApoE-deficient mice, which was not observed with normal-dose candesartan.

Structured PICO

Does high-dose candesartan induce regression of established atherosclerosis and lipid-induced nephropathy in apolipoprotein E-deficient spontaneously hyperlipidemic mice?

Population

Male apolipoprotein E-deficient spontaneously hyperlipidemic mice given an atherogenic diet and salt loading, treated for 12 weeks.

Intervention

Candesartan cilexetil at various doses (1, 10, or 50 mg/kg/day) dissolved in drinking water for 12 weeks.

Comparator

Control group receiving 0 mg/kg/day candesartan while maintained on the atherogenic diet, and a baseline group sacrificed at 16 weeks before treatment.

Outcome

Regression of atherosclerotic plaques in the aorta (assessed by Sudan IV-stained area) and aortic root (assessed by oil red O-stained area).surrogate

High-dose candesartan treatment can induce regression of established atherosclerotic lesions and lipid-induced nephropathy in a mouse model, potentially via mechanisms involving decreased biglycan and suppressed ACAT1 expression.

Abstract

AIM: Clinical studies have suggested that renin-angiotensin inhibitors are effective for the prevention of atherosclerosis progression, but the results for the regression of established lesions are equivocal. The aim of this study was to examine the effects of different doses of the angiotensin receptor blocker (ARB) candesartan on the regression of atherosclerosis and lipid-induced nephropathy in apolipoprotein E (apoE)-deficient spontaneously hyperlipidemic (SHL) mice. METHODS AND RESULTS: Male SHL were given an atherogenic diet together with salt loading to induce atherosclerosis. The mice were then treated with various doses of candesartan (0-50 mg/kg/d) for 12 weeks. Treatment with high-dose candesartan caused clear regression of atherosclerotic plaques in the aorta, which was not observed with normal-dose candesartan. Biglycan and ACAT1 expression were significantly decreased, and aortic free cholesterol: cholesterol ester ratios were increased in these mice. Treatment of cultured THP-1 macrophages in vitro with candesartan resulted in a similar decrease in ACAT1 expression. In the kidney, glomerular lipid accumulation, mesangial expansion, and albuminuria were significantly regressed after treatment with high-dose candesartan, while biglycan and ACAT1 expressions were decreased. CONCLUSION: These results suggest that regression of established atherosclerosis lesions in ApoE-deficient mice is feasible using high-dose candesartan, by mechanisms involving (i) a decrease in the lipid-retaining proteoglycan biglycan, and (ii) suppression of ACAT1 expression resulting in increased free cholesterol for lipid release.

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