Nontraditional Roles of Angiotensin-Converting Enzyme

Many articles have described the biochemistry of the renin-angiotensin system (RAS). Simply put, renin and angiotensin-converting enzyme (ACE) produce angiotensin II, which affects the brain (increased thirst), the gut (increased salt absorption), the adrenals (aldosterone production), the kidneys (salt and water retention), the heart (increased cardiac output), and vascular smooth muscle (vasoconstriction). Inhibitors of ACE and the angiotensin II type 1 receptor are now widely used to reduce blood pressure and to treat hypertension, heart failure, and renal disease.1 The effectiveness of these drugs and abundant data from animal models show that the RAS is the body's central mechanism for regulating blood pressure. Modern studies of the RAS have substantially broadened the known roles of this system by showing that angiotensin II influences cellular proliferation and the inflammatory response. Although this wider interpretation of the RAS encompasses more than control of blood pressure, it still focuses on the effects of angiotensin II in the context of vascular injury. This increased understanding of the RAS inevitably leads to the question of whether, even now, we fully understand all of the physiological roles of the RAS. Here, we argue that the answer is no, that nature uses the components of the RAS and, in particular, ACE for a wide variety of physiological tasks. ### ACE Is Necessary for Renal Development and Normal Male Fertility In understanding the function of the RAS, a powerful tool is the ability to genetically alter mouse genes. Knockout studies of angiotensinogen, renin, ACE, or the angiotensin II type 1 receptor have confirmed the important role of these proteins in regulating blood pressure, but they also underline the wider physiological role for the RAS.2 For example, adult mice lacking ACE show marked abnormalities of renal development characterized by hypertrophy of small arteries, interstitial fibrosis, atrophy of the inner medulla and renal papilla, and dilation of calyces. Renal …