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lüll Renin-angiotensin system blockers and modulation of radiation-induced brain injury Robbins ME; Zhao W; Garcia-Espinosa MA; Diz DICurr Drug Targets 2010[Nov]; 11 (11): 1413-22Radiation-induced brain injury remains a major cause of morbidity in cancer patients with primary or metastatic brain tumors. Approximately 200,000 individuals/year are treated with fractionated partial or whole-brain irradiation, and > half will survive long enough (=6 months) to develop radiation-induced brain injury, including cognitive impairment. Although short-term treatments have shown efficacy, no long-term treatments or preventive approaches are presently available for modulating radiation-induced brain injury. Based on previous preclinical studies clearly demonstrating that renin-angiotensin system (RAS) blockers can modulate radiation-induced late effects in the kidney and lung, we and others hypothesized that RAS blockade would similarly modulate radiation-induced brain injury. Indeed, studies in the last 5 years have shown that both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor antagonists (AT(1)RAs) can prevent/ameliorate radiation-induced brain injury, including cognitive impairment, in the rat. The mechanistic basis for this RAS blocker-mediated effect remains the subject of ongoing investigations. Putative mechanisms include, i] blockade of Ang II/NADPH oxidase-mediated oxidative stress and neuroinflammation, and ii] a change in the balance of angiotensin (Ang) peptides from the pro-inflammatory and pro-oxidative Ang II to the anti-inflammatory and anti-oxidative Ang-1-7). However, given that both ACEIs and AT(1)RAs are 1] well-tolerated drugs routinely prescribed for hypertension, 2] exhibit some antitumor properties, and 3] can prevent/ameliorate radiation-induced brain injury, they appear to be ideal drugs for future clinical trials, offering the promise of improving the quality of life of brain tumor patients receiving brain irradiation.|Angiotensin Receptor Antagonists/*pharmacology/therapeutic use[MESH]|Angiotensin-Converting Enzyme Inhibitors/*pharmacology/therapeutic use[MESH]|Animals[MESH]|Brain Injuries/*drug therapy/*etiology/prevention & control[MESH]|Brain Neoplasms/radiotherapy[MESH]|Brain/*radiation effects[MESH]|Humans[MESH]|Radiation Injuries/*drug therapy/prevention & control[MESH]|Renin-Angiotensin System/*drug effects[MESH] |