Objectives: Recent clinical trials have demonstrated that angiotensin-converting enzyme inhibitors (ACEIs) reduce thrombotic events by unknown mechanisms in patients with atherosclerotic cardiovascular diseases.
Design: We studied the in-vitro effects of perindopril, an ACEI, on the ability of human umbilical vein endothelial cells (HUVEC) to inhibit platelet aggregation.
Methods: Platelet aggregation in the presence of HUVEC and endothelial surface expression and activities of ecto-ATP diphosphohydrolase (ecto-ADPase), CD39, were determined. The capability of HUVEC to release prostacyclin and nitric oxide (NO) was also investigated.
Results: Perindoprilat (an active metabolite of perindopril) significantly enhanced the surface expression and activities of ecto-ADPase and prostacyclin release, resulting in enhancement of ability to inhibit platelet aggregation by HUVEC. These effects of perindoprilat were also observed in HUVEC activated by tumour necrosis factor (TNF)-alpha, which increased the expression of intracellular adhesion molecule-1 (ICAM-1), CD54, and, despite up-regulation of prostacyclin release, attenuated endothelial anti-platelet properties by decreasing ecto-ADPase activity. Perindoprilat partially restored this capability, but failed to reduce enhanced expression of ICAM-1. By contrast, the role of NO as a platelet inhibitor appeared minimal in HUVEC. Candesartan, an angiotensin II receptor (AT(1)) blocker, did not affect endothelial anti-platelet property.
Conclusions: Perindoprilat was found to augment endothelial capability to inhibit platelet aggregation by increasing ecto-ADPase activity and prostacyclin release in HUVEC. This beneficial effect of perindoprilat appeared to be preserved in the activated cells exposed to TNF-alpha, although no evidence was found to support that it could reverse the inflammation process induced by cytokines.