ACE inhibition limits chronic injury of kidney transplant even with treatment started when lesions are established

Marina Noris, Marilena Mister, Anna Pezzotta, Nadia Azzollini, Paola Cassis, Ariela Benigni, Elena Gagliardini, Norberto Perico, Giuseppe Remuzzi

Research output: Contribution to journalArticlepeer-review


Background. Inhibition of the renin-angiotensin system (RAS) prevents development of chronic allograft dysfunction in experimental animals. Whether this therapeutic approach is effective even if started when signs of allograft nephropathy are already manifested has not been investigated. Methods. To address this issue, we studied the effect of a late treatment with the angiotensin-convertine enzyme (ACE) inhibitor trandolapril in the Fisher 344 to Lewis rat kidney transplant model. Seven months after transplant a renal biopsy was done for graft histology examination. Thereafter rats received either no treatment (allograft-none) or trandolapril until sacrifice at month 13. Results. All animals were alive at the end of the study with the exception of a rat in the untreated group that died of renal insufficiency at day 292. Despite the fact that the grafts had already signs of structural injury and function impairment at the time treatment was stated, trandolapril completely restored renal function to baseline pretransplant values. Trandolapril also halted the progression of glomerular damage and suppressed intragraft T-lymphocyte infiltration and reduced the expression of the chemokine monocyte chemoattractant protein-1 (MCP-1). However, trandolapril had no direct effect on T cell function, since in vivo treatment did not modify recipient T-cell alloreactivity against donor antigens. Conclusion. These findings provide the basis for a novel treatment intervention with RAS blockade that, together with pharmacologic inhibition of the immune response, could interrupt progression of chronic allograft dysfunction and injury.

Original languageEnglish
Pages (from-to)2253-2261
Number of pages9
JournalKidney International
Issue number6
Publication statusPublished - Dec 2003


  • ACE inhibitor
  • Chemokine
  • Chronic allograft nephropathy
  • Rat kidney

ASJC Scopus subject areas

  • Nephrology


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