Published Online
on March 31, 2003

A more recent version of this article appeared on April 15, 2003

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Submitted on November 11, 2002
Revised on December 13, 2002
Accepted on December 17, 2002

Vasopeptidase Inhibitor Omapatrilat Induces Profound Insulin Sensitization and Increases Myocardial Glucose Uptake in Zucker Fatty Rats. Studies Comparing a Vasopeptidase Inhibitor, Angiotensin-Converting Enzyme Inhibitor, and Angiotensin II Type I Receptor Blocker

Chao-Hung Wang MD, Nathalie Leung MD, Nathalie Lapointe RN, MSc, Linda Szeto MSc, Kristine D. Uffelman MSc, Adria Giacca MD, Jean L. Rouleau MD, and Gary F. Lewis MD^*

From the Department of Medicine, Division of Endocrinology and Metabolism (C.W., N. Leung, L.S., K.D.U., A.G., G.F.L.), and the Department of Medicine, Division of Cardiology (N. Lapointe, J.L.R.), Toronto General Hospital and University Health Network; and the Department of Physiology, University of Toronto (A.G., G.F.L.), Toronto, Ontario, Canada.

^* To whom correspondence should be addressed. E-mail: gary.lewis{at}uhn.on.ca.

Background--ACE inhibitors (ACEIs) improve insulin resistance and prevent type 2 diabetes, possibly mediated by inhibition of bradykinin (BK) degradation. The vasopeptidase inhibitor omapatrilat (OMA) raises BK to a greater extent than ACEIs by dual enzyme inhibition, whereas its insulin-sensitizing effects and mechanisms have not been investigated.

Methods and Results--We compared the insulin-sensitizing effects of OMA, ramipril (an ACEI), losartan (an angiotensin II type 1 receptor blocker), and placebo by 2-step euglycemic hyperinsulinemic clamp in insulin-resistant Zucker fatty rats (n=6 to 7 in each group). OMA resulted in a lower rate of endogenous glucose production than placebo at baseline (35±5 versus 54±4 mmol · kg^-1 · min^-1, P<0.01), greater suppression of endogenous glucose production by low-dose insulin (73±11% versus 27±18%, P<0.05), and greater glucose disposal at high-dose insulin (135±5 versus 92±4 mmol · kg^-1 · min^-1, P<0.01). Ramipril tended to improve insulin sensitivity, but losartan did not. OMA significantly increased 2-deoxyglucose uptake by myocardium, fat, and skeletal muscle. Ramipril increased 2-deoxyglucose uptake only by some skeletal muscles, but losartan did not. The insulin-sensitizing effects of OMA were blocked significantly by HOE-140 (a BK, B₂ receptor antagonist) and N^G-nitro-L-arginine methyl ester (a nitric oxide synthase inhibitor) in all tissues except myocardium.

Conclusions--OMA induces profound insulin sensitization and increases myocardial glucose uptake in Zucker fatty rats. This effect is greater than that of ramipril and probably occurs at least in part via stimulation of the B₂ receptor. OMA has the potential for greater type 2 diabetes prevention than ACEI.

Key words: insulin • bradykinin • glucose • hypertension • diabetes mellitus

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