Vaccination: A novel strategy for inhibiting the renin-angiotensin-aldosterone system |
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Authors: | Alan H Gradman Rehka Pinto |
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Institution: | (1) Division of Cardiovascular Diseases, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA |
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Abstract: | Immunologic approaches to renin-angiotensin-aldosterone system (RAAS) inhibition have been studied for more than 50 years.
In animal models, vaccination against renin was effective but resulted in fatal autoimmune renal disease; vaccines directed
at small peptides including angiotensin I and II and a segment of the AT1 receptor reduced blood pressure (BP) without causing autoimmune disease. In humans, angiotensin I vaccination did not reduce
BP. More promising is the AngQb vaccine, which uses an immunization technology involving conjugation of angiotensin II to
virus-like particles. In a phase 2 trial, hypertensive patients vaccinated with 300 μg showed a difference of 9.0/4.0 mm Hg
from baseline in mean daytime ambulatory BP after 14 weeks (P = 0.015 for systolic BP, P = 0.064 for diastolic BP), and a marked reduction in early morning BP. No serious adverse events were attributed to vaccine
administration. Although questions remain regarding efficacy and safety, RAAS immunization represents an innovative and promising
approach to hypertension treatment. |
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