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Published in: Diabetologia 2/2004

01-02-2004 | Article

ACE-inhibition is superior to endothelin A receptor blockade in preventing abnormal capillary supply and fibrosis of the heart in experimental diabetes

Authors: Dr. M.-L. Groß, N. Heiß, M. Weckbach, A. Hansen, A. El-Shakmak, A. Szabo, K. Münter, E. Ritz, K. Amann

Published in: Diabetologia | Issue 2/2004

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Abstract

Aims/hypothesis

There is little information whether cardiac capillary supply is deranged in diabetes. Hyperglycaemia is a potent stimulus for endothelin-1 (ET-1) production. We therefore hypothesised that increased ET-1 production in Streptozotocin-induced Type 1 diabetes causes abnormalities of cardiac capillaries and the aorta. To this end we compared the effects of an ET receptor A blocker (ETA-RB) with that of an ACE-inhibitor (ACE-i) or their combination in rats with Streptozotocin (STZ) diabetes.

Methods

Sprague Dawley rats were injected with 65 mg STZ i.v. and subsequently developed diabetes. Rats were left untreated or received daily either the ACE-i Trandolapril, the ETA-RB Darusentan or a combination of both. After 6 months the experiment was terminated and the heart and the aorta were investigated using quantitative morphological techniques.

Results

ACE-i but not ETA-RB lowered blood pressure in STZ Type 1 diabetic rats. Capillary length density was lower in untreated STZ diabetic rats (2932±128 mm/mm3) compared to non-diabetic control rats (3410±252 mm/mm3). Treatment with ACE-i (3568±431 mm/mm3), but not with ETA-RB (2893±192 mm/mm3), prevented the decrease in capillary supply. Volume density of the myocardial interstitium was higher in untreated STZ diabetic rats (0.86±0.04%) compared to non-diabetic control rats (0.36±0.06%). In all three intervention groups the values were lower (ACE-i: 0.53±0.05%, ETA-RB: 0.7±0.08% and combination: 0.69±0.1).

Conclusion/interpretation

Our study identifies a capillary defect of the heart in STZ diabetes, i.e. decreased capillary supply. This abnormality was reversed by ACE-i, but not by ETA-R blockade. A similar trend, although not complete normalisation, was seen in cardiac fibrosis.
Literature
1.
go back to reference Fein FS, Sonnenblick EH (1994) Diabetic cardiomyopathy. Cardiovasc Drugs Ther 8:65–73PubMed Fein FS, Sonnenblick EH (1994) Diabetic cardiomyopathy. Cardiovasc Drugs Ther 8:65–73PubMed
2.
go back to reference Fischer M, Wiest G, Tekesin I et al. (1992) Effects of combined renovascular hypertension and diabetes mellitus on myocardial cells, non-vascular interstitium and capillaries: a stereological study on rat hearts. Virchows Arch A Pathol Anat Histopathol 420:499–506PubMed Fischer M, Wiest G, Tekesin I et al. (1992) Effects of combined renovascular hypertension and diabetes mellitus on myocardial cells, non-vascular interstitium and capillaries: a stereological study on rat hearts. Virchows Arch A Pathol Anat Histopathol 420:499–506PubMed
3.
go back to reference Standl E, Schnell O, Balletshofer B et al. (1997) Influence of diabetes mellitus on the heart and macrovascular mortality. Diabetologia 40 [Suppl 2]:S125–S126 Standl E, Schnell O, Balletshofer B et al. (1997) Influence of diabetes mellitus on the heart and macrovascular mortality. Diabetologia 40 [Suppl 2]:S125–S126
4.
go back to reference Suzuki T, Kumazaki T, Mitsui Y (1993) Endothelin-1 is produced and secreted by neonatal rat cardiac myocytes in vitro. Biochem Biophys Res Commun 191:823–830CrossRefPubMed Suzuki T, Kumazaki T, Mitsui Y (1993) Endothelin-1 is produced and secreted by neonatal rat cardiac myocytes in vitro. Biochem Biophys Res Commun 191:823–830CrossRefPubMed
5.
go back to reference Chua BH, Chua CC, Diglio CA, Siu BB (1998) Regulation of endothelin-1 mRNA by angiotensin II in rat heart endothelial cells. Biochim Biophys Acta 1178:201–206 Chua BH, Chua CC, Diglio CA, Siu BB (1998) Regulation of endothelin-1 mRNA by angiotensin II in rat heart endothelial cells. Biochim Biophys Acta 1178:201–206
6.
go back to reference Fukuchi M, Giaid A (1998) Expression of endothelin-1 and endothelin-converting enzyme-1 mRNAs and proteins in failing human hearts. J Cardiovasc Pharmacol 31 [Suppl 1]:S421–S423 Fukuchi M, Giaid A (1998) Expression of endothelin-1 and endothelin-converting enzyme-1 mRNAs and proteins in failing human hearts. J Cardiovasc Pharmacol 31 [Suppl 1]:S421–S423
7.
go back to reference Haynes WG, Ferro CJ, Webb DJ (1998) Bosentan in essential hypertension. N Engl J Med 339:346–347CrossRef Haynes WG, Ferro CJ, Webb DJ (1998) Bosentan in essential hypertension. N Engl J Med 339:346–347CrossRef
8.
go back to reference Haynes WG, Webb DJ (1998) Endothelin as a regulator of cardiovascular function in health and disease. J Hypertens 16:1081–1098PubMed Haynes WG, Webb DJ (1998) Endothelin as a regulator of cardiovascular function in health and disease. J Hypertens 16:1081–1098PubMed
9.
go back to reference Rabelink TJ, Stroes ES, Bouter KP, Morrison P (1998) Endothelin blockers and renal protection: a new strategy to prevent end-organ damage in cardiovascular disease? Cardiovasc Res 39:543–549CrossRefPubMed Rabelink TJ, Stroes ES, Bouter KP, Morrison P (1998) Endothelin blockers and renal protection: a new strategy to prevent end-organ damage in cardiovascular disease? Cardiovasc Res 39:543–549CrossRefPubMed
10.
go back to reference Rabelink TJ, Bakris GL (1998) The renin-angiotensin system in diabetic nephropathy: the endothelial connection. Miner Electrolyte Metab 24:381–388CrossRefPubMed Rabelink TJ, Bakris GL (1998) The renin-angiotensin system in diabetic nephropathy: the endothelial connection. Miner Electrolyte Metab 24:381–388CrossRefPubMed
11.
go back to reference Disashi T, Nonoguchi H, Iwaoka T et al. (1997) Endothelin converting enzyme-1 gene expression in the kidney of spontaneously hypertensive rats. Hypertension 30:1591–1597PubMed Disashi T, Nonoguchi H, Iwaoka T et al. (1997) Endothelin converting enzyme-1 gene expression in the kidney of spontaneously hypertensive rats. Hypertension 30:1591–1597PubMed
12.
go back to reference Verhaar MC, Strachan FE, Newby DE et al. (1998) Endothelin-A receptor antagonist-mediated vasodilatation is attenuated by inhibition of nitric oxide synthesis and by endothelin-B receptor blockade. Circulation 97:752–756PubMed Verhaar MC, Strachan FE, Newby DE et al. (1998) Endothelin-A receptor antagonist-mediated vasodilatation is attenuated by inhibition of nitric oxide synthesis and by endothelin-B receptor blockade. Circulation 97:752–756PubMed
13.
go back to reference Serneri GG, Cecioni I, Vanni S et al. (2000) Selective upregulation of cardiac endothelin system in patients with ischemic but not idiopathic dilated cardiomyopathy: endothelin-1 system in the human failing heart. Circ Res 86:377–385PubMed Serneri GG, Cecioni I, Vanni S et al. (2000) Selective upregulation of cardiac endothelin system in patients with ischemic but not idiopathic dilated cardiomyopathy: endothelin-1 system in the human failing heart. Circ Res 86:377–385PubMed
14.
go back to reference Takahashi K, Ghatei MA, Lam HC, O’Halloran DJ, Bloom SR (1999) Elevated plasma endothelin in patients with diabetes mellitus. Diabetologia 33:306–310 Takahashi K, Ghatei MA, Lam HC, O’Halloran DJ, Bloom SR (1999) Elevated plasma endothelin in patients with diabetes mellitus. Diabetologia 33:306–310
15.
go back to reference Misurski DA, Hopfner RL, McNeill JR, Gopalakrishnan V (1999) Endothelium-dependent alterations in responses of the mesenteric vascular bed in the streptozotocin diabetic rat. Proc West Pharmacol Soc 42:49–51PubMed Misurski DA, Hopfner RL, McNeill JR, Gopalakrishnan V (1999) Endothelium-dependent alterations in responses of the mesenteric vascular bed in the streptozotocin diabetic rat. Proc West Pharmacol Soc 42:49–51PubMed
16.
go back to reference Ficai S, Herizi A, Mimran A, Jover B (2001) Endothelin blockade in angiotensin II hypertension: prevention and treatment studies in the rat. Clin Exp Pharmacol Physiol 28:1100–1103CrossRefPubMed Ficai S, Herizi A, Mimran A, Jover B (2001) Endothelin blockade in angiotensin II hypertension: prevention and treatment studies in the rat. Clin Exp Pharmacol Physiol 28:1100–1103CrossRefPubMed
17.
go back to reference Gurbanov K, Rubinstein I, Hoffman A, Abassi Z, Better OS, Winaver J (1996) Bosentan improves renal regional blood flow in rats with experimental congestive heart failure. Eur J Pharmacol 310:193–196CrossRefPubMed Gurbanov K, Rubinstein I, Hoffman A, Abassi Z, Better OS, Winaver J (1996) Bosentan improves renal regional blood flow in rats with experimental congestive heart failure. Eur J Pharmacol 310:193–196CrossRefPubMed
18.
go back to reference Marin-Garcia J, Goldenthal MJ, Moe GW (2002) Selective endothelin receptor blockade reverses mitochondrial dysfunction in canine heart failure. J Card Fail 8:326–332CrossRefPubMed Marin-Garcia J, Goldenthal MJ, Moe GW (2002) Selective endothelin receptor blockade reverses mitochondrial dysfunction in canine heart failure. J Card Fail 8:326–332CrossRefPubMed
19.
go back to reference Nabokov AV, Amann K, Wessels S, Munter K, Wagner J, Ritz E (1999) Endothelin receptor antagonists influence cardiovascular morphology in uremic rats. Kidney Int 55:512–519CrossRefPubMed Nabokov AV, Amann K, Wessels S, Munter K, Wagner J, Ritz E (1999) Endothelin receptor antagonists influence cardiovascular morphology in uremic rats. Kidney Int 55:512–519CrossRefPubMed
20.
go back to reference Oie E, Clausen OP, Yndestad A, Grogaard HK, Attramadal H, Oie E (2002) Endothelin receptor antagonism attenuates cardiomyocyte apoptosis after induction of ischemia in rats. Scand Cardiovasc J 36:108–116CrossRefPubMed Oie E, Clausen OP, Yndestad A, Grogaard HK, Attramadal H, Oie E (2002) Endothelin receptor antagonism attenuates cardiomyocyte apoptosis after induction of ischemia in rats. Scand Cardiovasc J 36:108–116CrossRefPubMed
21.
go back to reference Amann K, Wolf B, Nichols C (1997) Aortic changes in experimental renal failure: hyperplasia or hypertrophy of smooth muscle cells? Hypertension 29:770–775PubMed Amann K, Wolf B, Nichols C (1997) Aortic changes in experimental renal failure: hyperplasia or hypertrophy of smooth muscle cells? Hypertension 29:770–775PubMed
22.
go back to reference Amann K, Munter K, Wessels S (2000) Endothelin A receptor blockade prevents capillary/myocyte mismatch in the heart of uremic animals. J Am Soc Nephrol 11:1702–1711PubMed Amann K, Munter K, Wessels S (2000) Endothelin A receptor blockade prevents capillary/myocyte mismatch in the heart of uremic animals. J Am Soc Nephrol 11:1702–1711PubMed
23.
go back to reference Henquell L, Odoroff CL, Honig CR (1997) Intercapillary distance and capillary reserve in hypertrophied rat hearts beating in situ. Circ Res 41:400–408 Henquell L, Odoroff CL, Honig CR (1997) Intercapillary distance and capillary reserve in hypertrophied rat hearts beating in situ. Circ Res 41:400–408
24.
go back to reference Buzello M, Boehm C, Orth S (2003) Myocyte loss in early left ventricular hypertrophy of experimental renovascular hypertension. Virchows Arch 442:364–371PubMed Buzello M, Boehm C, Orth S (2003) Myocyte loss in early left ventricular hypertrophy of experimental renovascular hypertension. Virchows Arch 442:364–371PubMed
25.
go back to reference Rodriguez-Porcel M, Lerman A, Ritman EL, Wilson SH, Best PJ, Lerman LO (2000) Altered myocardial microvascular 3D architecture in experimental hypercholesterolemia. Circulation 102:2028–2030PubMed Rodriguez-Porcel M, Lerman A, Ritman EL, Wilson SH, Best PJ, Lerman LO (2000) Altered myocardial microvascular 3D architecture in experimental hypercholesterolemia. Circulation 102:2028–2030PubMed
26.
go back to reference Kirchengast M, Munter K (1999) Endothelin-1 and endothelin receptor antagonists in cardiovascular remodeling. Proc Soc Exp Biol Med 221:312–325CrossRefPubMed Kirchengast M, Munter K (1999) Endothelin-1 and endothelin receptor antagonists in cardiovascular remodeling. Proc Soc Exp Biol Med 221:312–325CrossRefPubMed
27.
go back to reference Weber KT, Anversa P, Armstrong PW et al. (1992) Remodeling and reparation of the cardiovascular system. J Am Coll Cardiol 20:3–16PubMed Weber KT, Anversa P, Armstrong PW et al. (1992) Remodeling and reparation of the cardiovascular system. J Am Coll Cardiol 20:3–16PubMed
28.
go back to reference Weber KT, Brilla CG, Campbell SE, Guarda E, Zhou G, Sriram K (1993) Myocardial fibrosis: role of angiotensin II and aldosterone. Basic Res Cardiol 88 [Suppl 1]:107–124 Weber KT, Brilla CG, Campbell SE, Guarda E, Zhou G, Sriram K (1993) Myocardial fibrosis: role of angiotensin II and aldosterone. Basic Res Cardiol 88 [Suppl 1]:107–124
29.
go back to reference Weber KT, Brilla CG (1993) Structural basis for pathologic left ventricular hypertrophy. Clin Cardiol 16:II10–II14PubMed Weber KT, Brilla CG (1993) Structural basis for pathologic left ventricular hypertrophy. Clin Cardiol 16:II10–II14PubMed
30.
go back to reference Riva E, Andreoni G, Bianchi R (1998) Changes in diastolic function and collagen content in normotensive and hypertensive rats with long-term streptozotocin-induced diabetes. Pharmacol Res 37:233–240CrossRefPubMed Riva E, Andreoni G, Bianchi R (1998) Changes in diastolic function and collagen content in normotensive and hypertensive rats with long-term streptozotocin-induced diabetes. Pharmacol Res 37:233–240CrossRefPubMed
31.
go back to reference Candido R, Forbes JM, Thomas MC et al. (2003) A breaker of advanced glycation end products attenuates diabetes-induced myocardial structural changes. Circ Res 92:785–792CrossRefPubMed Candido R, Forbes JM, Thomas MC et al. (2003) A breaker of advanced glycation end products attenuates diabetes-induced myocardial structural changes. Circ Res 92:785–792CrossRefPubMed
32.
go back to reference Ayaz M, Can B, Ozdemir S, Turan B (2002) Protective effect of selenium treatment on diabetes-induced myocardial structural alterations. Biol Trace Elem Res 89:215–226CrossRefPubMed Ayaz M, Can B, Ozdemir S, Turan B (2002) Protective effect of selenium treatment on diabetes-induced myocardial structural alterations. Biol Trace Elem Res 89:215–226CrossRefPubMed
33.
go back to reference Dhein S, Hochreuther S, Aus Dem Spring C, Bollig K, Hufnagel C, Raschack M (2000) Long-term effects of the endothelin(A) receptor antagonist LU 135252 and the angiotensin-converting enzyme inhibitor trandolapril on diabetic angiopathy and nephropathy in a chronic type I diabetes mellitus rat model. J Pharmacol Exp Ther 293:351–359PubMed Dhein S, Hochreuther S, Aus Dem Spring C, Bollig K, Hufnagel C, Raschack M (2000) Long-term effects of the endothelin(A) receptor antagonist LU 135252 and the angiotensin-converting enzyme inhibitor trandolapril on diabetic angiopathy and nephropathy in a chronic type I diabetes mellitus rat model. J Pharmacol Exp Ther 293:351–359PubMed
34.
go back to reference Cavasin MA, Carretero OA, Yang F, Oja-Tebbe N, Peng H, Yang XP (2002) Long-term effects of selective and nonselective endothelin receptor antagonists in mice with heart failure. J Card Fail 8:254–261CrossRefPubMed Cavasin MA, Carretero OA, Yang F, Oja-Tebbe N, Peng H, Yang XP (2002) Long-term effects of selective and nonselective endothelin receptor antagonists in mice with heart failure. J Card Fail 8:254–261CrossRefPubMed
35.
go back to reference Basso C, Thiene G, Della Barbera M, Angelini A, Kirchengast M, Iliceto S (2002) Endothelin A-receptor antagonist administration immediately after experimental myocardial infarction with reperfusion does not affect scar healing in dogs. Cardiovasc Res 55:113–121CrossRefPubMed Basso C, Thiene G, Della Barbera M, Angelini A, Kirchengast M, Iliceto S (2002) Endothelin A-receptor antagonist administration immediately after experimental myocardial infarction with reperfusion does not affect scar healing in dogs. Cardiovasc Res 55:113–121CrossRefPubMed
36.
go back to reference Mathiesen ER, Borch-Johnsen K, Jensen DV, Deckert T (1989) Improved survival in patients with diabetic nephropathy. Diabetologia 32:884–886 Mathiesen ER, Borch-Johnsen K, Jensen DV, Deckert T (1989) Improved survival in patients with diabetic nephropathy. Diabetologia 32:884–886
37.
go back to reference Hong SW, Isono M, Chen S, Iglesias-De La Cruz MC, Han DC, Ziyadeh FN (2001) Increased glomerular and tubular expression of transforming growth factor-beta1, its type II receptor, and activation of the Smad signaling pathway in the db/db mouse. Am J Pathol 158:1653–1663PubMed Hong SW, Isono M, Chen S, Iglesias-De La Cruz MC, Han DC, Ziyadeh FN (2001) Increased glomerular and tubular expression of transforming growth factor-beta1, its type II receptor, and activation of the Smad signaling pathway in the db/db mouse. Am J Pathol 158:1653–1663PubMed
38.
go back to reference Woods LL, Mizelle HL, Hall JE (1987) Control of renal hemodynamics in hyperglycemia: possible role of tubuloglomerular feedback. Am J Physiol 252:F65–F73PubMed Woods LL, Mizelle HL, Hall JE (1987) Control of renal hemodynamics in hyperglycemia: possible role of tubuloglomerular feedback. Am J Physiol 252:F65–F73PubMed
39.
go back to reference Cai L, Li W, Wang G, Guo L, Jiang Y, Kang YJ (2002) Hyperglycemia-induced apoptosis in mouse myocardium: mitochondrial cytochrome C-mediated caspase-3 activation pathway. Diabetes 51:1938–1948 Cai L, Li W, Wang G, Guo L, Jiang Y, Kang YJ (2002) Hyperglycemia-induced apoptosis in mouse myocardium: mitochondrial cytochrome C-mediated caspase-3 activation pathway. Diabetes 51:1938–1948
40.
go back to reference Benigni A, Colosio V, Brena C, Bruzzi I, Bertani T, Remuzzi G (1998) Unselective inhibition of endothelin receptors reduces renal dysfunction in experimental diabetes. Diabetes 47:450–456 Benigni A, Colosio V, Brena C, Bruzzi I, Bertani T, Remuzzi G (1998) Unselective inhibition of endothelin receptors reduces renal dysfunction in experimental diabetes. Diabetes 47:450–456
41.
go back to reference Nabokov A, Amann K, Wagner J, Gehlen F, Munter K, Ritz E (1996) Influence of specific and non-specific endothelin receptor antagonists on renal morphology in rats with surgical renal ablation. Nephrol Dial Transplant 11:514–520PubMed Nabokov A, Amann K, Wagner J, Gehlen F, Munter K, Ritz E (1996) Influence of specific and non-specific endothelin receptor antagonists on renal morphology in rats with surgical renal ablation. Nephrol Dial Transplant 11:514–520PubMed
42.
go back to reference Witte K, Reitenbach I, Stolpe K, Schilling L, Kirchengast M, Lemmer B (2003) Effects of the endothelin a receptor antagonist darusentan on blood pressure and vascular contractility in type 2 diabetic Goto-Kakizaki rats. J Cardiovasc Pharmacol 41:890–896CrossRefPubMed Witte K, Reitenbach I, Stolpe K, Schilling L, Kirchengast M, Lemmer B (2003) Effects of the endothelin a receptor antagonist darusentan on blood pressure and vascular contractility in type 2 diabetic Goto-Kakizaki rats. J Cardiovasc Pharmacol 41:890–896CrossRefPubMed
43.
go back to reference Verma S, Maitland A, Weisel RD et al. (2002) Hyperglycemia exaggerates ischemia-reperfusion-induced cardiomyocyte injury: reversal with endothelin antagonism. J Thorac Cardiovasc Surg 123:1120–1124CrossRefPubMed Verma S, Maitland A, Weisel RD et al. (2002) Hyperglycemia exaggerates ischemia-reperfusion-induced cardiomyocyte injury: reversal with endothelin antagonism. J Thorac Cardiovasc Surg 123:1120–1124CrossRefPubMed
44.
go back to reference Vesci L, Mattera GG, Tobia P, Corsico N, Calvani M (1995) Cardiac and renal endothelin-1 binding sites in streptozotocin-induced diabetic rats. Pharmacol Res 32:363–367PubMed Vesci L, Mattera GG, Tobia P, Corsico N, Calvani M (1995) Cardiac and renal endothelin-1 binding sites in streptozotocin-induced diabetic rats. Pharmacol Res 32:363–367PubMed
45.
go back to reference Crespo MJ, Moreta S, Gonzalez J (2003) Cardiovascular deterioration in STZ-diabetic rats: possible role of vascular RAS. Pharmacology 68:1–8CrossRefPubMed Crespo MJ, Moreta S, Gonzalez J (2003) Cardiovascular deterioration in STZ-diabetic rats: possible role of vascular RAS. Pharmacology 68:1–8CrossRefPubMed
46.
go back to reference Fiordaliso F, Li B, Latini R (2000) Myocyte death in streptozotocin-induced diabetes in rats in angiotensin II-dependent. Lab Invest 80:513–527PubMed Fiordaliso F, Li B, Latini R (2000) Myocyte death in streptozotocin-induced diabetes in rats in angiotensin II-dependent. Lab Invest 80:513–527PubMed
47.
go back to reference Park JB, Schiffrin EL (2001) ET(A) receptor antagonist prevents blood pressure elevation and vascular remodeling in aldosterone-infused rats. Hypertension 37:1444–1449PubMed Park JB, Schiffrin EL (2001) ET(A) receptor antagonist prevents blood pressure elevation and vascular remodeling in aldosterone-infused rats. Hypertension 37:1444–1449PubMed
48.
go back to reference Zoja C, Orisio S, Perico N (1991) Constitutive expression of endothelin gene in cultured human mesangial cells and its modulation by transforming growth factor-beta, thrombin, and a thromboxane A2 analogue. Lab Invest 64:16–20PubMed Zoja C, Orisio S, Perico N (1991) Constitutive expression of endothelin gene in cultured human mesangial cells and its modulation by transforming growth factor-beta, thrombin, and a thromboxane A2 analogue. Lab Invest 64:16–20PubMed
49.
go back to reference Kurihara H, Yoshizumi M, Sugiyama T et al. (1998) Transforming growth factor-beta stimulates the expression of endothelin mRNA by vascular endothelial cells. Biochem Biophys Res Commun 159:1435–1440 Kurihara H, Yoshizumi M, Sugiyama T et al. (1998) Transforming growth factor-beta stimulates the expression of endothelin mRNA by vascular endothelial cells. Biochem Biophys Res Commun 159:1435–1440
50.
go back to reference Gilbert RE, Rumble JR, Cao Z (2000) Endothelin receptor antagonism ameliorates mast cell infiltration, vascular hypertrophy, and epidermal growth factor expression in experimental diabetes. Circ Res 86:158–165PubMed Gilbert RE, Rumble JR, Cao Z (2000) Endothelin receptor antagonism ameliorates mast cell infiltration, vascular hypertrophy, and epidermal growth factor expression in experimental diabetes. Circ Res 86:158–165PubMed
Metadata
Title
ACE-inhibition is superior to endothelin A receptor blockade in preventing abnormal capillary supply and fibrosis of the heart in experimental diabetes
Authors
Dr. M.-L. Groß
N. Heiß
M. Weckbach
A. Hansen
A. El-Shakmak
A. Szabo
K. Münter
E. Ritz
K. Amann
Publication date
01-02-2004
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 2/2004
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-003-1309-z

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