Abstract 479: Ex vivo Equilibrium Analysis of the Renin-Angiotensin-System: Clinical Implications for Diagnosis and Treatment of Hypertension

Abstract

The concentrations of angiotensins are maintained by equal rates of formation and degradation. The resulting steady-state angiotensin levels are affected by local molecular factors including tissue, endothelium or blood cell associated angiotensin receptors and processing enzymes as well as plasma soluble RAS components. The high concentration of the pro-hormone angiotensinogen in human plasma in combination with reported ranges for plasma renin activity result in a long-lasting and stable Ang I formation rate without significantly reducing angiotensinogen levels within several hours. This phenomenon can be utilized for the generation of an ex vivo situation that is characterized by significantly higher but stable angiotensin peptide levels. These ex vivo equilibrium angiotensin levels provide an integrated picture about plasma angiotensinase activities and therefore represent a powerful diagnostic tool for analyzing the systemic RAS in clinical samples. Moreover, these ex vivo levels remain stable over hours of incubation at 37°C and show a very high correlation (>90%) with angiotensin levels obtained by a state-of-the art sample collection procedure using complex inhibitor cocktails for stabilizing angiotensin peptides during blood collection. The quantification of equilibrium angiotensin levels does not require any special sample collection procedures and can be applied to frozen serum and heparin plasma samples. It turned out that ex vivo angiotensin levels represent a measure for the consumption of angiotensin metabolites by the organism, therefore providing a powerful and versatile tool for assessing in vivo angiotensin signaling on the patient specific level enabling new diagnosis based rationales for anti-hypertensive therapies. The application of ex vivo RAS-Fingerprinting in clinical studies could substantially enhance our understanding of the regulation and physiology of the human RAS and could further lead to the development of powerful personalized approaches in the future treatment of hypertension.