Deterioration of kidney function by the (pro)renin receptor blocker handle region peptide in aliskiren-treated diabetic transgenic (mRen2)27 rats

Am J Physiol Renal Physiol. 2014 May 15;306(10):F1179-89. doi: 10.1152/ajprenal.00010.2014. Epub 2014 Apr 2.


Dual renin-angiotensin system (RAS) blockade in diabetic nephropathy is no longer feasible because of the profit/side effect imbalance. (Pro)renin receptor [(P)RR] blockade with handle region peptide (HRP) has been reported to exert beneficial effects in various diabetic models in a RAS-independent manner. To what degree (P)RR blockade adds benefits on top of RAS blockade is still unknown. In the present study, we treated diabetic TGR(mREN2)27 rats, a well-established nephropathy model with high prorenin levels [allowing continuous (P)RR stimulation in vivo], with HRP on top of renin inhibition with aliskiren. Aliskiren alone lowered blood pressure and exerted renoprotective effects, as evidenced by reduced glomerulosclerosis, diuresis, proteinuria, albuminuria, and urinary aldosterone levels as well as diminished renal (P)RR and ANG II type 1 receptor expression. It also suppressed plasma and tissue RAS activity and suppressed cardiac atrial natriuretic peptide and brain natriuretic peptide expression. HRP, when given on top of aliskiren, did not alter the effects of renin inhibition on blood pressure, RAS activity, or aldosterone. However, it counteracted the beneficial effects of aliskiren in the kidney, induced hyperkalemia, and increased plasma plasminogen activator-inhibitor 1, renal cyclooxygenase-2, and cardiac collagen content. All these effects have been linked to (P)RR stimulation, suggesting that HRP might, in fact, act as a partial agonist. Therefore, the use of HRP on top of RAS blockade in diabetic nephropathy is not advisable.

Keywords: (pro)renin receptor blockade; diabetes; kidney; prorenin; renin inhibition.

MeSH terms

  • Aldosterone / metabolism
  • Amides / pharmacology*
  • Animals
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Cyclooxygenase 2 / metabolism
  • Diabetes Mellitus, Experimental / chemically induced
  • Diabetes Mellitus, Experimental / physiopathology*
  • Disease Models, Animal
  • Female
  • Fumarates / pharmacology*
  • Kidney / drug effects*
  • Kidney / physiopathology*
  • Male
  • Oligopeptides / pharmacology*
  • Plasminogen Activator Inhibitor 1 / metabolism
  • Potassium / metabolism
  • Rats
  • Rats, Sprague-Dawley
  • Rats, Transgenic
  • Receptors, Cell Surface / antagonists & inhibitors*
  • Receptors, Cell Surface / drug effects
  • Renin / genetics*
  • Renin-Angiotensin System / drug effects
  • Renin-Angiotensin System / physiology
  • Streptozocin / adverse effects


  • Amides
  • Fumarates
  • Oligopeptides
  • Plasminogen Activator Inhibitor 1
  • Receptors, Cell Surface
  • Ren2 protein, rat
  • handle-region peptide, rat
  • prorenin receptor
  • Aldosterone
  • aliskiren
  • Streptozocin
  • Cyclooxygenase 2
  • Renin
  • Potassium