PMID- 11967013 OWN - NLM STAT- MEDLINE DCOM- 20021028 LR - 20131121 IS - 0085-2538 (Print) IS - 0085-2538 (Linking) VI - 61 IP - 5 DP - 2002 May TI - Effect of combining ACE inhibitor and statin in severe experimental nephropathy. PG - 1635-45 AB - BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitor therapy given soon after disease induction uniformly prevents proteinuria in virtually all models of disease progression. This does not necessarily apply to patients with proteinuric nephropathies, who might be referred late in the course of their disease. Here we used a severe rat model of passive Heymann nephritis (PHN), which may mimic advanced phases of human membranous nephropathy, to study the response to ACE inhibitor alone or in combination with a HMG CoA reductase inhibitor (statin) that independently of the cholesterol-lowering effect influences pathways involved in inflammatory and fibrogenic processes. Therapies started when animals had massive proteinuria and renal lesions. METHODS: PHN was accelerated by uninephrectomy seven days after IV injection of rabbit anti-FX1A antibody. Four months later, when massive proteinuria and renal lesions were present, the rats were divided into five groups and daily given orally: vehicle; lisinopril 40 mg/L; lisinopril 400 mg/L; simvastatin 2 mg/kg b.i.d; or lisinopril 40 mg/L plus simvastatin. Six normal rats served as controls. Animals were sacrificed at 10 months. RESULTS: By the end of the study three PHN rats died in the vehicle group, four in the group given lisinopril at 40 mg/L and two in the group at 400 mg/L, whereas all rats on simvastatin or combined therapy were alive. Blood pressure increased during time in PHN and was normalized by treatment with ACE inhibitor and combined therapy. Even at the high dose lisinopril failed to reduce proteinuria. Simvastatin only partially affected proteinuria. However, combining lisinopril with simvastatin had a remarkable antiproteinuric effect, such that at 10 months the urinary proteins were comparable to pre-treatment values and significantly lower than either the vehicle or lisinopril groups. Hypercholesterolemia of PHN rats was limited by combined therapy, and a positive correlation was found between serum cholesterol and proteinuria. Renal function was only partially ameliorated by simvastatin but significantly improved by combined therapy. Drug combination significantly limited glomerulosclerosis, tubular damage and interstitial inflammation, compared to vehicle or drugs alone. Up-regulation of monocyte chemoattractant protein-1 (MCP-1) mRNA in PHN kidneys was not affected by lisinopril, it was inhibited by 30% after simvastatin, and almost completely normalized by lisinopril plus simvastatin. CONCLUSIONS: These data suggest that a combined ACE inhibitor and statin approach could represent a therapeutic option for patients with advanced renal disease in whom ACE inhibitors alone fail to lower proteinuria and injury to any substantial extent. FAU - Zoja, Carla AU - Zoja C AD - Mario Negri Institute for Pharmacological Research, and Unit of Nephrology and Dialysis, Azienda Ospedaliera, Ospedali Riuniti di Bergamo, Bergamo, Italy. zoja@marionegri.it FAU - Corna, Daniela AU - Corna D FAU - Rottoli, Daniela AU - Rottoli D FAU - Cattaneo, Dario AU - Cattaneo D FAU - Zanchi, Cristina AU - Zanchi C FAU - Tomasoni, Susanna AU - Tomasoni S FAU - Abbate, Mauro AU - Abbate M FAU - Remuzzi, Giuseppe AU - Remuzzi G LA - eng PT - Journal Article PL - United States TA - Kidney Int JT - Kidney international JID - 0323470 RN - 0 (Angiotensin-Converting Enzyme Inhibitors) RN - 0 (Chemokine CCL2) RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (RNA, Messenger) RN - 0 (Triglycerides) RN - 97C5T2UQ7J (Cholesterol) RN - AGG2FN16EV (Simvastatin) RN - E7199S1YWR (Lisinopril) RN - EC 2.6.1.1 (Aspartate Aminotransferases) RN - EC 2.6.1.2 (Alanine Transaminase) SB - IM MH - Alanine Transaminase/blood MH - Angiotensin-Converting Enzyme Inhibitors/*pharmacology MH - Animals MH - Aspartate Aminotransferases/blood MH - Blood Pressure MH - Body Weight MH - CD4-Positive T-Lymphocytes/pathology MH - Chemokine CCL2/genetics MH - Cholesterol/blood MH - Disease Models, Animal MH - Drug Therapy, Combination MH - Eating MH - Glomerulonephritis/*drug therapy/immunology/pathology MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*pharmacology MH - Kidney/pathology/physiology MH - Lisinopril/*pharmacology MH - Male MH - Proteinuria/drug therapy/immunology/pathology MH - RNA, Messenger/analysis MH - Rats MH - Rats, Sprague-Dawley MH - Simvastatin/*pharmacology MH - Triglycerides/blood EDAT- 2002/04/23 10:00 MHDA- 2002/10/29 04:00 CRDT- 2002/04/23 10:00 PHST- 2002/04/23 10:00 [pubmed] PHST- 2002/10/29 04:00 [medline] PHST- 2002/04/23 10:00 [entrez] AID - S0085-2538(15)48400-5 [pii] AID - 10.1046/j.1523-1755.2002.00332.x [doi] PST - ppublish SO - Kidney Int. 2002 May;61(5):1635-45. doi: 10.1046/j.1523-1755.2002.00332.x.