The Renin Angiotensin System and Diabetes

Abstract

The Renin Angiotensin System (RAS) is clearly implicated in the physiopathology of diabetes mellitus (DM). The frequent association of diabetes mellitus (DM) with hypertension, retinopathy, nephropathy, and cardiovascular disease has implicated the RAS in the initiation and progression of these complications of DM. This has been supported by clinical trials in which RAS inhibitors significantly reduced the incidence of vascular complications in DM patients. The main RAS mediator, Angiotensin II (Ang II), exerts several deleterious actions in patients with DM, including increase in insulin resistance, endothelial damage and deterioration of renal function. On the other hand, only few studies have reported the potential protective role of the stimulation of the conter-regulatory RAS axis formed by the enzyme homologue to ACE, ACE2, the heptapeptide Angiotensin-(1-7) {[}Ang-(1-7)] and its receptor, the proto-oncogene Mas. In this review, we report recent experimental and clinical evidence in relation to ACE2 stimulation and Mas receptor agonists as potential therapeutic targets for DM.