Background: Pancreatic cancers often develop in the context of pancreatic fibrosis caused by chronic pancreas inflammation, which also results in the accumulation of reactive oxygen species (ROS), pancreatic parenchymal cell death, and stellate cell activation. Angiotensin II, which is converted from angiotensin I by the angiotensin-converting enzyme (ACE), stimulates ROS production via NADPH oxidase. In stellate cells, angiotensin II activates the stress-activated protein kinase p38. However, the molecular mechanism by which angiotensin II regulates pancreatic inflammation and fibrosis remains to be determined. Methods: Wistar Bonn/Kobori (WBN/Kob) rats spontaneously develop chronic pancreatic inflammation. To examine whether blockade of the renin-angiotensin system affects the development of pancreatic fibrosis, WBN/Kob rats were given angiotensin II type 1 receptor (AT1R) blocker or ACE inhibitor (ACEI). Next, we assessed the role of angiotensin II and its possible downstream target p38α in stellate cell activation using primary stellate cells. Results: Treatment with AT1R blocker and ACEI prevented the development of chronic pancreatitis and fibrosis. In stellate cells, angiotensin II upregulated the expression of angiotensin II receptors, α-smooth muscle actin (SMA) and transforming growth factor-β. In addition, p38α was found to be essential to collagen type I production and α-SMA expression. ROS accumulation is enhanced in chronic pancreatic inflammation, which increases the risk of pancreatic cancer. Conclusions: Inhibition of the angiotensin II signaling pathway might be a promising strategy to prevent pancreatic fibrogenesis and subsequent carcinogenesis.

1.
Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR, et al: Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993;328:1433–1437.
2.
Ammann RW, Muellhaupt B: Progression of alcoholic acute to chronic pancreatitis. Gut 1994;35:552–556.
3.
Oparil S, Haber E: The renin-angiotensin system. N Engl J Med 1974;291:389–401.
4.
Timmermans PB, Wong PC, Chiu AT, Herblin WF, Benfield P, Carini DJ, et al: Angiotensin II receptors and angiotensin II receptor antagonists. Pharmacol Rev 1993;45:205–251.
5.
Dijkhorst-Oei LT, Stroes ES, Koomans HA, Rabelink TJ: Acute simultaneous stimulation of nitric oxide and oxygen radicals by angiotensin II in humans in vivo. J Cardiovasc Pharmacol 1999;33:420–424.
6.
Landmesser U, Cai H, Dikalov S, McCann L, Hwang J, Jo H, Holland SM, Harrison DG: Role of p47(phox) in vascular oxidative stress and hypertension caused by angiotensin II. Hypertension 2002;40:511–515.
7.
Reinehr R, Zoller S, Klonowski-Stumpe H, Kordes C, Häussinger D: Effects of angiotensin II on rat pancreatic stellate cells. Pancreas 2004;28:129–137.
8.
Yamada T, Kuno A, Masuda K, Ogawa K, Sogawa M, Nakamura S, et al: Candesartan, an angiotensin II receptor antagonist, suppresses pancreatic inflammation and fibrosis in rats. J Pharmacol Exp Ther 2003;307:17–23.
9.
Ulmasov B, Xu Z, Talkad V, Oshima K, Neuschwander-Tetri BA: Angiotensin II signaling through the AT1a and AT1b receptors does not have a role in the development of cerulein-induced chronic pancreatitis in the mouse. Am J Physiol Gastrointest Liver Physiol 2010;299:G70–G80.
10.
Tsang SW, Ip SP, Wong TP, Che CT, Leung PS: Differential effects of saralasin and ramiprilat, the inhibitors of renin-angiotensin system, on cerulein-induced acute pancreatitis. Regul Pept 2003;111:47–53.
11.
Tsang SW, Ip SP, Leung PS: Prophylactic and therapeutic treatments with AT 1 and AT 2 receptor antagonists and their effects on changes in the severity of pancreatitis. Int J Biochem Cell Biol 2004;36:330–339.
12.
Apte MV, Phillips PA, Fahmy RG, Darby SJ, Rodgers SC, McCaughan GW, et al: Does alcohol directly stimulate pancreatic fibrogenesis? Studies with rat pancreatic stellate cells. Gastroenterology 2000;118:780–794.
13.
Yoshiji H, Kuriyama S, Yoshii J, Ikenaka Y, Noguchi R, Nakatani T, et al: Angiotensin-II type I receptor interaction is a major regulator for liver fibrosis development in rats. Hepatology 2001;94:745–750.
14.
Nishida K, Yamaguchi O, Hirotani S, Hikoso S, Higuchi Y, Watanabe T, et al: p38α mitogen-activated protein kinase plays a critical role in cardiomyocyte survival but not in cardiac hypertrophic growth in response to pressure overload. Mol Cell Biol 2004;24:10611–10620.
15.
Sakurai T, He G, Matsuzawa A, Yu GY, Maeda S, Hardiman G, et al: Hepatocyte necrosis induced by oxidative stress and IL-1 alpha release mediate carcinogen-induced compensatory proliferation and liver tumorigenesis. Cancer Cell 2008;14:156–165.
16.
Passino MA, Adams RA, Sikorski SL, Akassoglou K: Regulation of hepatic stellate cell differentiation by the neurotrophin receptor p75NTR. Science 2007;315:1853–1856.
17.
Masamune A, Suzuki N, Kikuta K, Satoh M, Satoh K, Shimosegawa T: Curcumin blocks activation of pancreatic stellate cells. J Cell Biochem 2006;97:1080–1093.
18.
Schnabl B, Kweon YO, Frederick JP, Wang XF, Rippe RA, Brenner DA: The role of Smad3 in mediating mouse hepatic stellate cell activation. Hepatology 2001;34:89–100.
19.
Shimizu K: Mechanisms of pancreatic fibrosis and applications to the treatment of chronic pancreatitis. J Gastroenterol 2008;43:823–832.
20.
Klöppel G, Maillet B: The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis. Virchows Arch A Pathol Anat Histopathol 1992;420:1–4.
21.
Neuschwander-Tetri BA, Bridle KR, Wells LD, Marcu M, Ramm GA: Repetitive acute pancreatic injury in the mouse induces procollagen alpha1(I) expression colocalized to pancreatic stellate cells. Lab Invest 2000;80:143–150.
22.
Van Laethem JL, Robberecht P, Résibois A, Devière J: Transforming growth factor beta promotes development of fibrosis after repeated courses of acute pancreatitis in mice. Gastroenterology 1996;110:576–582.
23.
Bataller R, Brenner DA: Liver fibrosis. J Clin Invest 2005;115:209–218.
24.
Wada T, Inada Y, Ojima M, Sanada T, Shibouta Y, Nishikawa K: Comparison of the antihypertensive effects of the new angiotensin II (AT1) receptor antagonist candesartan cilexetil (TCV-116) and the angiotensin converting enzyme inhibitor enalapril in rats. Hypertens Res 1996;19:75–81.
25.
Ulmasov B, Xu Z, Tetri LH, Inagami T, Neuschwander-Tetri BA: Protective role of angiotensin II type 2 receptor signaling in a mouse model of pancreatic fibrosis. Am J Physiol Gastrointest Liver Physiol 2009;296:G284–G294.
26.
Ames BN: Dietary carcinogens and anticarcinogens. Oxygen radicals and degenerative diseases. Science 1983;221:1256–1264.
27.
Woo RA, Poon RY: Activated oncogenes promote and cooperate with chromosomal instability for neoplastic transformation. Genes Dev 2004;18:1317–1330.
28.
Allen RG, Tresini M: Oxidative stress and gene regulation. Free Radic Biol Med 2000;28:463–499.
29.
Toyokuni S: Novel aspects of oxidative stress-associated carcinogenesis. Antioxid Redox Signal 2006;8:1373–1377.
30.
Dhillon AS, Hagan S, Rath O, Kolch W: MAP kinase signalling pathways in cancer. Oncogene 2007;26:3279–3290.
31.
Cuenda A, Rousseau S: p38 MAP-kinases pathway regulation, function and role in human diseases. Biochim Biophys Acta 2007;1773:1358–1375.
32.
Allen M, Svensson L, Roach M, Hambor J, McNeish J, Gabel CA: Deficiency of the stress kinase p38α results in embryonic lethality: characterization of the kinase dependence of stress responses of enzyme-deficient embryonic stem cells. J Exp Med 2000;191:859–870.
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