Novel actions of angiotensin II via its renal type-2 (AT2) receptor

The vast majority of the biologic effects of angiotensin II have been considered to be mediated by the subtype-1 (AT₁) receptor. The AT₂ receptor is expressed to a low degree in most adult cells and tissues, and its function has not been understood. Recent studies, however, have identified novel actions of angiotensin II mediated by the AT₂ receptor in the kidney. These AT₂ receptor actions have importance in the control of blood pressure and hypertension. The AT₂ receptor mediates a renal vasodilator cascade, including generation of bradykinin, nitric oxide, and cyclic GMP. This action of angiotensin II occurs when the renin-angiotensin system is activated, as in sodium depletion. The AT₂ receptor also appears to mediate prostaglandin (PG) F_α formation, probably by stimulating conversion of PGE2 to PGF_α. The AT₂ receptor plays a counter-regulatory vasodilator role opposing the vasoconstrictor actions of angiotensin II. The AT₁ and AT₂ receptors engage in inter-receptor “cross-talk.” In the absence of the AT₂ receptor, sustained angiotensin II pressor and antinatriuretic hypersensitivity occurs, mediated by a deficiency of bradykinin, nitric oxide, and cyclic GMP. The AT₂ receptor may play an important role in stimulating pressure natriuresis, but definitive studies are required to resolve this issue. The AT₂ receptor mediates several renal actions of angiotensin II, appears to be important in the physiologic regulation of blood pressure, and may be involved in the pathophysiology of hypertension.