Korean J Intern Med.  2018 May;33(3):453-461. 10.3904/kjim.2017.317.

Role of the renin-angiotensin system in hepatic fibrosis and portal hypertension

• Shim KY
• Eom YW
• Kim MY
• Kang SH
• Baik SK

• KMID: 2411571
• DOI: http://doi.org/10.3904/kjim.2017.317

Abstract

The renin-angiotensin system (RAS) is an important regulator of cirrhosis and portal hypertension. As hepatic fibrosis progresses, levels of the RAS components angiotensin (Ang) II, Ang-(1-7), angiotensin-converting enzyme (ACE), and Ang II type 1 receptor (AT1R) are increased. The primary effector Ang II regulates vasoconstriction, sodium homoeostasis, fibrosis, cell proliferation, and inflammation in various diseases, including liver cirrhosis, through the ACE/Ang II/AT1R axis in the classical RAS. The ACE2/Ang-(1-7)/Mas receptor and ACE2/Ang-(1-9)/AT2R axes make up the alternative RAS and promote vasodilation, antigrowth, proapoptotic, and anti-inflammatory effects; thus, countering the effects of the classical RAS axis to reduce hepatic fibrogenesis and portal hypertension. Patients with portal hypertension have been treated with RAS antagonists such as ACE inhibitors, Ang receptor blockers, and aldosterone antagonists, with very promising hemodynamic results. In this review, we examine the RAS, its roles in hepatic fibrosis and portal hypertension, and current therapeutic approaches based on the use of RAS antagonists in patients with portal hypertension.

Keyword

Renin-angiotensin system; Hepatic fibrosis; Hypertension, portal; Angiotensins; Receptors, angiotensin

MeSH Terms

Angiotensin-Converting Enzyme Inhibitors
Angiotensins
Cell Proliferation
Fibrosis*
Hemodynamics
Humans
Hypertension, Portal*
Inflammation
Liver Cirrhosis
Mineralocorticoid Receptor Antagonists
Receptors, Angiotensin
Renin-Angiotensin System*
Sodium
Vasoconstriction
Vasodilation
Angiotensin-Converting Enzyme Inhibitors
Angiotensins
Mineralocorticoid Receptor Antagonists
Receptors, Angiotensin
Sodium