Abstract. angiotensin ii (anG ii) type 2 receptor (aT2r) has been recognized to suppress the proliferation of vascular smooth muscle cells (VSMcs). The aim of the present study was to determine whether aT2r overexpression inhibits neointimal hyperplasia in a rat carotid arterial balloon injury model and to examine the underlying mechanisms of its activity. Balloon-injured rats receiving ad-aT2r showed significant diminutions in neointimal area and intima/ media ratio compared to non-treated rats or rats receiving adenovirus containing green fluorescent protein (Ad-GFP). In addition, extracellular regulated kinase 1/2 (ERK1/2) and basic transcription element-binding protein 2 (BTeB2) were significantly down-regulated in the arteries and VSMCs of Ad-AT2R-treated rats and compared to Ad-GFP-treated rats. However, ad-aT2r transfection failed to affect the expression of anG ii type 1 receptor (aT1r) in carotid arteries and cultured VSMcs. The present study provides direct evidence that AT2R plays a beneficial role in balloon injury-induced neointimal hyperplasia, which is mainly attributed to the inhibition of VSMc proliferation and involves the down-regulation of the ERK1/2 and BTEB2 pathways, but is independent of the expression of aT1r.
IntroductionPercutaneous transluminal balloon angioplasty is widely used for the treatment of obstructed atherosclerotic vascular diseases (1). However, balloon injury to the arterial wall induced by restenosis limits its overall benefits (2). Despite dramatic advances in reducing the incidence of restenosis by drug-eluting stents, it remains a considerable medical challenge (3-5). The major pathological process underlying restenosis is neointimal hyperplasia (6), which results from the phenotypic modulation, proliferation, migration and extracellular matrix synthesis of vascular smooth muscle cells (VSMcs) (7).release of angiotensin ii (anG ii) in response to vascular injury plays an important role in neointimal hyperplasia through the stimulation of VSMc proliferation and migration (8,9). Two distinct subtypes of anG ii receptors, type 1 (AT1R) and type 2 (AT2R), have been identified. The proliferation effect of anG ii has been attributed to aT1r (10,11). additionally, treatment with aT1r blockers (arBs) reduces the incidence of restenosis (12,13). aT2r is expressed abundantly in the fetal vasculature with rapid decline after birth, and is re-expressed in the adult vasculature under certain pathological cardiovascular conditions, such as vessel injury and inflammation (14,15). In injured vessels, aT1r is highly expressed, while aT2r is expressed at low levels (16). Furthermore, it has been reported that aT2r has anti-proliferation, anti-migration and proapoptotic effects on VSMcs in vitro, and antagonizes the growth effect of aT1r (17,18). These lines of evidence suggest that aT2r plays a crucial role in the neointimal hyperplasia response to vascular injury.in this study, we investigated the effects of the overexpression of aT2r by adenoviral gene transfer on neointimal hyperpla...