Cardiovascular disease progression in female Zucker Diabetic Fatty rats occurs via unique mechanisms compared to males

Population studies have shown that compared to diabetic men, diabetic women are at a higher risk of cardiovascular disease. However, the mechanisms underlying this gender disparity are unclear. Our studies in young murine models of type 2 diabetes mellitus (T2DM) and cardiovascular disease show that diabetic male rats develop increased cardiac fibrosis and suppression of intracardiac anti-fibrotic cytokines, while premenopausal diabetic female rats do not. This protection from cardiac fibrosis in female rats can be an estrogen-related effect. However, diabetic female rats develop early subclinical myocardial deformation, cardiac hypertrophy via elevated expression of pro-hypertrophic miR-208a, myocardial damage, and suppression of cardio-reparative Angiotensin II receptor 2 (Agtr2). Diabetic rats of both sexes exhibit a reduction in cardiac capillary density. However, diabetic female rats have reduced expression of neuropilin 1 that attenuates cardiomyopathy compared to diabetic male rats. A combination of cardiac hypertrophy and reduced capillary density likely contributed to increased myocardial structural damage in diabetic female rats. We propose expansion of existing cardiac assessments in diabetic female patients to detect myocardial deformation, cardiac hypertrophy and capillary density via non-invasive imaging, as well as suggest miR-208a, AT2R and neuropilin 1 as potential therapeutic targets and mechanistic biomarkers for cardiac disease in females.

Dipeptidyl Peptidase-4 Inhibition With Saxagliptin Ameliorates Angiotensin II-Induced Cardiac Diastolic Dysfunction in Male Mice

Activation of the renin-angiotensin-aldosterone system is common in hypertension and obesity and contributes to cardiac diastolic dysfunction, a condition for which no treatment currently exists. In light of recent reports that antihyperglycemia incretin enhancing dipeptidyl peptidase (DPP)-4 inhibitors exert cardioprotective effects, we examined the hypothesis that DPP-4 inhibition with saxagliptin (Saxa) attenuates angiotensin II (Ang II)-induced cardiac diastolic dysfunction. Male C57BL/6J mice were infused with either Ang II (500 ng/kg/min) or vehicle for 3 weeks receiving either Saxa (10 mg/kg/d) or placebo during the final 2 weeks. Echocardiography revealed Ang II-induced diastolic dysfunction, evidenced by impaired septal wall motion and prolonged isovolumic relaxation, coincident with aortic stiffening. Ang II induced cardiac hypertrophy, coronary periarterial fibrosis, TRAF3-interacting protein 2 (TRAF3IP2)-dependent proinflammatory signaling [p-p65, p-c-Jun, interleukin (IL)-17, IL-18] associated with increased cardiac macrophage, but not T cell, gene expression. Flow cytometry revealed Ang II-induced increases of cardiac CD45+F4/80+CD11b+ and CD45+F4/80+CD11c+ macrophages and CD45+CD4+ lymphocytes. Treatment with Saxa reduced plasma DPP-4 activity and abrogated Ang II-induced cardiac diastolic dysfunction independent of aortic stiffening or blood pressure. Furthermore, Saxa attenuated Ang II-induced periarterial fibrosis and cardiac inflammation, but not hypertrophy or cardiac macrophage infiltration. Analysis of Saxa-induced changes in cardiac leukocytes revealed Saxa-dependent reduction of the Ang II-mediated increase of cardiac CD11c messenger RNA and increased cardiac CD8 gene expression and memory CD45+CD8+CD44+ lymphocytes. In summary, these results demonstrate that DPP-4 inhibition with Saxa prevents Ang II-induced cardiac diastolic dysfunction, fibrosis, and inflammation associated with unique shifts in CD11c-expressing leukocytes and CD8+ lymphocytes.

Abstract P522: Endothelial Cell-specific Knockout of Epithelial Sodium Channel Prevents Aortic Stiffness, Cardiac Stiffness and Diastolic Dysfunction in Response to a Western Diet in Female Mice

A western diet (WD), high in fructose and fat, is often accompanied by insulin resistance and cardiovascular disease characterized by endothelial cell (EC) dysfunction, increased arterial and cardiac stiffness, and diastolic dysfunction. Although premenopausal non-obese women are protected against cardiovascular disease, arterial stiffness and diastolic dysfunction, in obese women these abnormalities are more pronounced than in men. We have recently developed a clinically relevant, WD fed, murine model that exhibits increased aortic stiffness associated with vascular and cardiac dysfunction. In this model, female mice have high plasma aldosterone levels and increased mineralocorticoid receptor expression (MR) in both the vasculature and heart. One of the mechanisms by which MR activation promotes endothelial stiffness is through increased expression and activation of epithelial sodium channel (ENaC) in ECs (EnNaC). We reported increased aortic EC stiffness associated with increased expression of EnNaC in WD fed mice and suppression of aortic stiffness and improved diastolic function by treatment with a low dose of an MR antagonist or the ENaC inhibitor, amiloride. In this study, we tested the hypothesis that specific deletion of EnNaC, decreases aortic EC stiffness and improves vascular relaxation and diastolic function in WD fed female mice. To produce cell specific deletion of the EnNaC gene,”floxed” EnNaC mice were serially crossed with Tie 2-Cre transgene mice. This resulted in marked suppression of EnNaC expression in ECs. Female KO mice and littermate controls were fed a WD with high in fat (46%) and fructose (17.5%) for 12 weeks. Compared to mice fed a control diet (CD), aortic EC stiffness, measured ex vivo by atomic force microscopy (AFM) was significantly increased in WD fed mice and this was prevented in EnNaC KO mice fed WD. Decreased EC stiffness was associated with improved endothelial-dependent aortic relaxation in response to acetylcholine. Moreover, deletion of EnNaC also prevented WD induced impairment of diastolic function. Taken together, these findings support the notion that a WD promotes ECMR mediated activation of EnNaC and associated aortic stiffness, cardiac stiffness and diastolic dysfunction.

Abstract 120: Endothelial Specific Sodium Channel Activation in Endothelium Dysfunction and Vascular Stiffness in Obese Female Mice

Excessive activation of endothelial cell (EC) mineralocorticoid receptor (ECMR) signaling induces EC epithelial sodium channel (EnNaC) activity to promote cardiovascular stiffness. Our previous study has demonstrated that activated ECMR signaling prompts expression and translocation of EnNaC to the EC surface inducing fibrosis, inflammation, and macrophage infiltration in the vasculature of female mice fed a western diet (WD). As ECMR KO also prevented these abnormalities, we posit that ECMR/EnNaC activation was critical. Accordingly, we hypothesized that EC-specific EnNaC activation would mediate endothelium dysfunction, vascular stiffness, and impair flow-mediated vasodilation through reduction of bioavailable NO. Four week old C57BL6/J mice were fed a WD containing high fat (46%), sucrose (17.5%), and high fructose corn syrup (17.5%) with or without a low dose of amiloride (1 mg/kg/day) for 16 weeks. Female EnNaC KO and wild-type littermate females were treated with aldosterone (250 μg/kg/day) via osmotic minipumps for 3 weeks. Amiloride, an antagonist for EnNaC, significantly inhibited inward Na+ currents and EnNaC activity in the cultured endothelial cells. Amiloride treatment significantly attenuated WD-induced increases in aortic stiffness in vivo as measured by pulse wave velocity and in vitro endothelial stiffness measured by atomic force microscopy. In addition, amiloride improved flow mediated dilation in mesenteric arteries and endothelium-dependent relaxation in response to acetylcholine (10 -9 -10 -4 mol/L). Furthermore, amiloride prevented WD-induced increases in coronary endothelium permeability that were associated with decreased expression of claudin-5 and occluding. This also resulted in reduction of total macrophage recruitment (CD11b) and M1 polarization (CD11c). Importantly, genetic knock-out EnNaC KO also prevented aldosterone-induced endothelium stiffening and impairment of endothelium-dependent relaxation. These data indicate that EC specific EnNaC activation decreases bioavailable NO, increases vascular endothelium dysfunction, and prompts vascular stiffening in obese female mice.

Amiloride Improves Endothelial Function and Reduces Vascular Stiffness in Female Mice Fed a Western Diet

Obese premenopausal women lose their sex related cardiovascular disease protection and develop greater arterial stiffening than age matched men. In female mice, we have shown that consumption of a Western diet (WD), high in fat and refined sugars, is associated with endothelial dysfunction and vascular stiffening, which occur via activation of mineralocorticoid receptors and associated increases in epithelial Na⁺ channel (ENaC) activity on endothelial cells (EnNaC). Herein our aim was to determine the effect that reducing EnNaC activity with a very-low-dose of amiloride would have on decreasing endothelial and arterial stiffness in young female mice consuming a WD. To this end, we fed female mice either a WD or control diet and treated them with or without a very-low-dose of the ENaC-inhibitor amiloride (1 mg/kg/day) in the drinking water for 20 weeks beginning at 4 weeks of age. Mice consuming a WD were heavier and had greater percent body fat, proteinuria, and aortic stiffness as assessed by pulse-wave velocity than those fed control diet. Treatment with amiloride did not affect body weight, body composition, blood pressure, urinary sodium excretion, or insulin sensitivity, but significantly reduced the development of endothelial and aortic stiffness, aortic fibrosis, aortic oxidative stress, and mesenteric resistance artery EnNaC abundance and proteinuria in WD-fed mice. Amiloride also improved endothelial-dependent vasodilatory responses in the resistance arteries of WD-fed mice. These results indicate that a very-low-dose of amiloride, not affecting blood pressure, is sufficient to improve endothelial function and reduce aortic stiffness in female mice fed a WD, and suggest that EnNaC-inhibition may be sufficient to ameliorate the pathological vascular stiffening effects of WD-induced obesity in females.

Dipeptidyl peptidase-4 (DPP-4) inhibition with linagliptin reduces western diet-induced myocardial TRAF3IP2 expression, inflammation and fibrosis in female mice

Background

Diastolic dysfunction (DD), a hallmark of obesity and primary defect in heart failure with preserved ejection fraction, is a predictor of future cardiovascular events. We previously reported that linagliptin, a dipeptidyl peptidase-4 inhibitor, improved DD in Zucker Obese rats, a genetic model of obesity and hypertension. Here we investigated the cardioprotective effects of linagliptin on development of DD in western diet (WD)-fed mice, a clinically relevant model of overnutrition and activation of the renin-angiotensin-aldosterone system.

Methods

Female C56Bl/6 J mice were fed an obesogenic WD high in fat and simple sugars, and supplemented or not with linagliptin for 16 weeks.

Results

WD induced oxidative stress, inflammation, upregulation of Angiotensin II type 1 receptor and mineralocorticoid receptor (MR) expression, interstitial fibrosis, ultrastructural abnormalities and DD. Linagliptin inhibited cardiac DPP-4 activity and prevented molecular impairments and associated functional and structural abnormalities. Further, WD upregulated the expression of TRAF3IP2, a cytoplasmic adapter molecule and a regulator of multiple inflammatory mediators. Linagliptin inhibited its expression, activation of its downstream signaling intermediates NF-κB, AP-1 and p38-MAPK, and induction of multiple inflammatory mediators and growth factors that are known to contribute to development and progression of hypertrophy, fibrosis and contractile dysfunction. Linagliptin also inhibited WD-induced collagens I and III expression. Supporting these in vivo observations, linagliptin inhibited aldosterone-mediated MR-dependent oxidative stress, upregulation of TRAF3IP2, proinflammatory cytokine, and growth factor expression, and collagen induction in cultured primary cardiac fibroblasts. More importantly, linagliptin inhibited aldosterone-induced fibroblast activation and migration.

Conclusions

Together, these in vivo and in vitro results suggest that inhibition of DPP-4 activity by linagliptin reverses WD-induced DD, possibly by targeting TRAF3IP2 expression and its downstream inflammatory signaling.

Sodium glucose transporter 2 (SGLT2) inhibition with empagliflozin improves cardiac diastolic function in a female rodent model of diabetes

Obese and diabetic individuals are at increased risk for impairments in diastolic relaxation and heart failure with preserved ejection fraction. The impairments in diastolic relaxation are especially pronounced in obese and diabetic women and predict future cardiovascular disease (CVD) events in this population. Recent clinical data suggest sodium glucose transporter-2 (SGLT2) inhibition reduces CVD events in diabetic individuals, but the mechanisms of this CVD protection are unknown. To determine whether targeting SGLT2 improves diastolic relaxation, we utilized empagliflozin (EMPA) in female db/db mice. Eleven week old female db/db mice were fed normal mouse chow, with or without EMPA, for 5 weeks. Blood pressure (BP), HbA1c and fasting glucose were significantly increased in untreated db/db mice (DbC) (P < 0.01). EMPA treatment (DbE) improved glycemic indices (P < 0.05), but not BP (P > 0.05). At baseline, DbC and DbE had already established impaired diastolic relaxation as indicated by impaired septal wall motion (>tissue Doppler derived E'/A' ratio) and increased left ventricular (LV) filling pressure (<E/E' ratio). Although these abnormalities persisted throughout the study period in DbC, diastolic function improved with EMPA treatment. In DbC, myocardial fibrosis was accompanied by increased expression of profibrotic/prohypertrophic proteins, serum/glucocorticoid regulated kinase 1 (SGK1) and the epithelial sodium channel (ENaC), and the development of these abnormalities were reduced with EMPA. DbC exhibited eccentric LV hypertrophy that was slightly improved by EMPA, indicated by a reduction in cardiomyocyte cross sectional area. In summary, EMPA improved glycemic indices along with diastolic relaxation, as well as SGK1/ENaC profibrosis signaling and associated interstitial fibrosis, all of which occurred in the absence of any changes in BP.

Targeting TRAF3IP2 by Genetic and Interventional Approaches Inhibits Ischemia/Reperfusion-induced Myocardial Injury and Adverse Remodeling

Re-establishing blood supply is the primary goal for reducing myocardial injury in subjects with ischemic heart disease. Paradoxically, reperfusion results in nitroxidative stress and a marked inflammatory response in the heart. TRAF3IP2 (TRAF3 Interacting Protein 2; previously known as CIKS or Act1) is an oxidative stress-responsive cytoplasmic adapter molecule that is an upstream regulator of both IκB kinase (IKK) and c-Jun N-terminal kinase (JNK), and an important mediator of autoimmune and inflammatory responses. Here we investigated the role of TRAF3IP2 in ischemia/reperfusion (I/R)-induced nitroxidative stress, inflammation, myocardial dysfunction, injury, and adverse remodeling. Our data show that I/R up-regulates TRAF3IP2 expression in the heart, and its gene deletion, in a conditional cardiomyocyte-specific manner, significantly attenuates I/R-induced nitroxidative stress, IKK/NF-κB and JNK/AP-1 activation, inflammatory cytokine, chemokine, and adhesion molecule expression, immune cell infiltration, myocardial injury, and contractile dysfunction. Furthermore, Traf3ip2 gene deletion blunts adverse remodeling 12 weeks post-I/R, as evidenced by reduced hypertrophy, fibrosis, and contractile dysfunction. Supporting the genetic approach, an interventional approach using ultrasound-targeted microbubble destruction-mediated delivery of phosphorothioated TRAF3IP2 antisense oligonucleotides into the LV in a clinically relevant time frame significantly inhibits TRAF3IP2 expression and myocardial injury in wild type mice post-I/R. Furthermore, ameliorating myocardial damage by targeting TRAF3IP2 appears to be more effective to inhibiting its downstream signaling intermediates NF-κB and JNK. Therefore, TRAF3IP2 could be a potential therapeutic target in ischemic heart disease.

Daily exercise prevents diastolic dysfunction and oxidative stress in a female mouse model of western diet induced obesity by maintaining cardiac heme oxygenase-1 levels

OBJECTIVE

Obesity is a global epidemic with profound cardiovascular disease (CVD) complications. Obese women are particularly vulnerable to CVD, suffering higher rates of CVD compared to non-obese females. Diastolic dysfunction is the earliest manifestation of CVD in obese women but remains poorly understood with no evidence-based therapies. We have shown early diastolic dysfunction in obesity is associated with oxidative stress and myocardial fibrosis. Recent evidence suggests exercise may increase levels of the antioxidant heme oxygenase-1 (HO-1). Accordingly, we hypothesized that diastolic dysfunction in female mice consuming a western diet (WD) could be prevented by daily volitional exercise with reductions in oxidative stress, myocardial fibrosis and maintenance of myocardial HO-1 levels.

MATERIALS/METHODS

Four-week-old female C57BL/6J mice were fed a high-fat/high-fructose WD for 16weeks (N=8) alongside control diet fed mice (N=8). A separate cohort of WD fed females was allowed a running wheel for the entire study (N=7). Cardiac function was assessed at 20weeks by high-resolution cardiac magnetic resonance imaging (MRI). Functional assessment was followed by immunohistochemistry, transmission electron microscopy (TEM) and Western blotting to identify pathologic mechanisms and assess HO-1 protein levels.

RESULTS

There was no significant body weight decrease in exercising mice, normalized body weight 14.3g/mm, compared to sedentary mice, normalized body weight 13.6g/mm (p=0.38). Total body fat was also unchanged in exercising, fat mass of 6.6g, compared to sedentary mice, fat mass 7.4g (p=0.55). Exercise prevented diastolic dysfunction with a significant reduction in left ventricular relaxation time to 23.8ms for exercising group compared to 33.0ms in sedentary group (p<0.01). Exercise markedly reduced oxidative stress and myocardial fibrosis with improved mitochondrial architecture. HO-1 protein levels were increased in the hearts of exercising mice compared to sedentary WD fed females.

CONCLUSIONS

This study provides seminal evidence that exercise can prevent diastolic dysfunction in WD-induced obesity in females even without changes in body weight. Furthermore, the reduction in myocardial oxidative stress and fibrosis and improved HO-1 levels in exercising mice suggests a novel mechanism for the antioxidant effect of exercise.

Abstract P295: Endothelial Sodium Channel Activation Promotes Cardiac Stiffness in Obese Female Mice

Cardiac diastolic dysfunction (DD) and diastolic heart failure is increasing in concert with obesity and aging population in the United States. In obese and diabetic women, DD is more common than in their male counterparts. This disproportionate increase in DD in obese females may partly explain their loss of sex-related cardiovascular (CV) disease protection. Recent studies have suggested a role for endothelial sodium channel (ENaC) activation in promotion of endothelial stiffness and suppression of flow- (nitric oxide) mediated vasodilation. Moreover, increased mineralocorticoid receptor (MR) activation mediated endothelial stiffness is promoted, in part, by ENaC activation. In this regard, we have recently reported increased plasma aldosterone levels, aortic and cardiac stiffness, and cardiac and vascular MR expression in female mice fed a high fat and high fructose diet (western diet [WD]). This increase in CV stiffness was prevented by very low dose MR antagonism. Accordingly, we hypothesized that inhibition of MR-mediated ENaC activation by using a very low dose of the ENaC inhibitor, amiloride would prevent cardiac stiffening (DD) in WD-fed female mice. Four week old C57BL6/J mice were fed a WD containing high fat (46%), sucrose (17.5%), and high fructose corn syrup (17.5%) with or without a very low dose of amiloride (1mg/kg/day) for 16 weeks. Amiloride significantly attenuated WD-induced impairment of cardiac relaxation in vivo as measured by high resolution magnetic resonance imaging (MRI) as well as cardiac interstitial fibrosis as measured by immunohistochemistry by picrosirius red staining. Moreover, amiloride prevented the development of DD in obese female mice without having effects on blood pressure. These observations support a role for ENaC activation in diet-induced cardiac stiffening (DD) in obese females.

Abstract 127: Enhanced Endothelial Mineralocorticoid Receptor Signaling Prompts Vascular Inflammation and Stiffness Through MiRNA-103-mediated Suppression of KLF4

Enhanced activation of mineralocorticoid receptors (MRs) impairs insulin metabolic signaling, increases oxidative stress, and induces inflammation with associated cardiovascular abnormalities. Our previous data in female mice suggests that activation of endothelial cell MRs (ECMR) contributes to development of vascular stiffness partly by impairing insulin metabolic signaling and reducing endothelial derived nitic oxide (NO) production. Emerging information suggests that microRNA 103 (miR103) is upregulated and thus promotes endothelial inflammation and atherosclerosis in both ob/ob mice and western diet-induced obese C57BL/6J mice. However, the interaction of ECMR and miR103 in the promotion of vascular inflammation and stiffness has not been explored. We hypothesized that ECMR signaling prompts vascular inflammation and stiffness through miRNA-103-mediated suppression of Kruppel-like factor-4 (KLF4). Female ECMR knockout (ECMR -/- ) and wild-type littermate females were treated with aldosterone (Aldo) (250 μg/kg/day) via osmotic minipumps for 4 weeks. Aldo infusion induced endothelium stiffness and impaired aortic relaxation in wild-type mice as determined by ex vivo atomic force microscopy and wire myograph techniques, respectively. The elevated aortic stiffness and impaired relaxation was accompanied by increases in expression of miR103 and intercellular adhesion molecule 1 (ICAM-1) and a reduction in phosphorylation of serine (Ser) 1177/activation of endothelial NO synthase (eNOS). These Aldo-induced endothelial abnormalities were prevented in ECMR -/- mice. Furthermore, application of a miR103 inhibitor to ECs in vitro attenuated Aldo (10 8 M)-induced a decrease in KLF4 expression, which has anti-inflammatory functions mediated by upregulation of phosphorylation of eNOS and downregulation of ICAM-1. These findings suggest that increased ECMR signaling and associated miR103 activation plays a key role in Aldo-induced KLF4 suppression and associated vascular inflammation and aortic stiffness in females.

Abstract P293: Endothelial Sodium Channel Activation Promotes Vascular Stiffness in Obese Female Mice

Obesity-associated arterial stiffening is an independent predictor of cardiovascular disease (CVD) events. Although premenopausal non-obese women are protected against CVD, aortic stiffening in obese women is more common than in men. This disproportionate increase in vascular stiffness in obese females may partly explain their loss of sex-related CVD protection. Recent studies have suggested a role for endothelial sodium channel (ENaC) activation in promotion of endothelial stiffness and suppression of flow-(nitric oxide) mediated vasodilation. Increased mineralocorticoid receptor (MR) activation mediated endothelial stiffness is promoted, in part, by ENaC activation. In this regard, we have recently reported increased aortic stiffness, MR and ENaC expression and endothelial dysfunction in female mice fed a high fat and high fructose diet (western diet [WD]). This increase in aortic stiffness was prevented by very low dose MR antagonism. Accordingly, we hypothesized that inhibition of MR-mediated ENaC activation by using a very low dose of the ENaC inhibitor, amiloride, would prevent arterial stiffening and vascular dysfunction in WD-fed female mice. Four week old C57BL6/J mice were fed a WD containing high fat (46%), sucrose (17.5%), and high fructose corn syrup (17.5%) with or without a very low dose of amiloride (1mg/kg/day) for 16 weeks. Amiloride significantly attenuated WD-induced increases in aortic stiffness in vivo as measured by pulse wave velocity as well as in vitro endothelial stiffness as measured by atomic force microscopy. Moreover, incubation of aortic explants with very low dose of amiloride (1 μM) inhibited WD-induced aortic stiffness in aorta explants from WD-fed female mice. Amiloride also prevented WD-induced impairment in acetylcholine-induced aortic vasodilatation and flow-mediated dilation in mesenteric arteries. Taken together, these observations support a role for ENaC activation in diet-induced vascular stiffening in obese females.

Regular Exercise Reduces Endothelial Cortical Stiffness in Western Diet-Fed Female Mice

We recently showed that Western diet-induced obesity and insulin resistance promotes endothelial cortical stiffness in young female mice. Herein, we tested the hypothesis that regular aerobic exercise would attenuate the development of endothelial and whole artery stiffness in female Western diet-fed mice. Four-week-old C57BL/6 mice were randomized into sedentary (ie, caged confined, n=6) or regular exercise (ie, access to running wheels, n=7) conditions for 16 weeks. Exercise training improved glucose tolerance in the absence of changes in body weight and body composition. Compared with sedentary mice, exercise-trained mice exhibited reduced endothelial cortical stiffness in aortic explants (sedentary 11.9±1.7 kPa versus exercise 5.5±1.0 kPa; P<0.05), as assessed by atomic force microscopy. This effect of exercise was not accompanied by changes in aortic pulse wave velocity (P>0.05), an in vivo measure of aortic stiffness. In comparison, exercise reduced femoral artery stiffness in isolated pressurized arteries and led to an increase in femoral internal artery diameter and wall cross-sectional area (P<0.05), indicative of outward hypertrophic remodeling. These effects of exercise were associated with an increase in femoral artery elastin content and increased number of fenestrae in the internal elastic lamina (P<0.05). Collectively, these data demonstrate for the first time that the aortic endothelium is highly plastic and, thus, amenable to reductions in stiffness with regular aerobic exercise in the absence of changes in in vivo whole aortic stiffness. Comparatively, the same level of exercise caused destiffening effects in peripheral muscular arteries, such as the femoral artery, that perfuse the working limbs.

Endothelial Estrogen Receptor-α Does Not Protect Against Vascular Stiffness Induced by Western Diet in Female Mice

Consumption of a diet high in fat and refined carbohydrates (Western diet [WD]) is associated with obesity and insulin resistance, both major risk factors for cardiovascular disease (CVD). In women, obesity and insulin resistance abrogate the protection against CVD likely afforded by estrogen signaling through estrogen receptor (ER)α. Indeed, WD in females results in increased vascular stiffness, which is independently associated with CVD. We tested the hypothesis that loss of ERα signaling in the endothelium exacerbates WD-induced vascular stiffening in female mice. We used a novel model of endothelial cell (EC)-specific ERα knockout (EC-ERαKO), obtained after sequential crossing of the ERα double floxed mice and VE-Cadherin Cre-recombinase mice. Ten-week-old females, EC-ERαKO and aged-matched genopairs were fed either a regular chow diet (control diet) or WD for 8 weeks. Vascular stiffness was measured in vivo by pulse wave velocity and ex vivo in aortic explants by atomic force microscopy. In addition, vascular reactivity was assessed in isolated aortic rings. Initial characterization of the model fed a control diet did not reveal changes in whole-body insulin sensitivity, aortic vasoreactivity, or vascular stiffness in the EC-ERαKO mice. Interestingly, ablation of ERα in ECs reduced WD-induced vascular stiffness and improved endothelial-dependent dilation. In the setting of a WD, endothelial ERα signaling contributes to vascular stiffening in females. The precise mechanisms underlying the detrimental effects of endothelial ERα in the setting of a WD remain to be elucidated.

Insulin resistance and hyperinsulinaemia in diabetic cardiomyopathy

Insulin resistance, type 2 diabetes mellitus and associated hyperinsulinaemia can promote the development of a specific form of cardiomyopathy that is independent of coronary artery disease and hypertension. Termed diabetic cardiomyopathy, this form of cardiomyopathy is a major cause of morbidity and mortality in developed nations, and the prevalence of this condition is rising in parallel with increases in the incidence of obesity and type 2 diabetes mellitus. Of note, female patients seem to be particularly susceptible to the development of this complication of metabolic disease. The diabetic cardiomyopathy observed in insulin- resistant or hyperinsulinaemic states is characterized by impaired myocardial insulin signalling, mitochondrial dysfunction, endoplasmic reticulum stress, impaired calcium homeostasis, abnormal coronary microcirculation, activation of the sympathetic nervous system, activation of the renin-angiotensin-aldosterone system and maladaptive immune responses. These pathophysiological changes result in oxidative stress, fibrosis, hypertrophy, cardiac diastolic dysfunction and eventually systolic heart failure. This Review highlights a surge in diabetic cardiomyopathy research, summarizes current understanding of the molecular mechanisms underpinning this condition and explores potential preventive and therapeutic strategies.

Endothelial Mineralocorticoid Receptor Mediates Diet-Induced Aortic Stiffness in Females

RATIONALE

Enhanced activation of the mineralocorticoid receptors (MRs) in cardiovascular tissues increases oxidative stress, maladaptive immune responses, and inflammation with associated functional vascular abnormalities. We previously demonstrated that consumption of a Western diet (WD) for 16 weeks results in aortic stiffening, and that these abnormalities were prevented by systemic MR blockade in female mice. However, the cell-specific role of endothelial cell MR (ECMR) in these maladaptive vascular effects has not been explored.

OBJECTIVE

We hypothesized that specific deletion of the ECMR would prevent WD-induced increases in endothelial sodium channel activation, reductions in bioavailable nitric oxide, increased vascular remodeling, and associated increases in vascular stiffness in females.

METHODS AND RESULTS

Four-week-old female ECMR knockout and wild-type mice were fed either mouse chow or WD for 16 weeks. WD feeding resulted in aortic stiffness and endothelial dysfunction as determined in vivo by pulse wave velocity and ex vivo by atomic force microscopy, and wire and pressure myography. The WD-induced aortic stiffness was associated with enhanced endothelial sodium channel activation, attenuated endothelial nitric oxide synthase activation, increased oxidative stress, a proinflammatory immune response and fibrosis. Conversely, cell-specific ECMR deficiency prevented WD-induced aortic fibrosis and stiffness in conjunction with reductions in endothelial sodium channel activation, oxidative stress and macrophage proinflammatory polarization, restoration of endothelial nitric oxide synthase activation.

CONCLUSIONS

Increased ECMR signaling associated with consumption of a WD plays a key role in endothelial sodium channel activation, reduced nitric oxide production, oxidative stress, and inflammation that lead to aortic remodeling and stiffness in female mice.

Endothelial Mineralocorticoid Receptor Deletion Prevents Diet-Induced Cardiac Diastolic Dysfunction in Females

Overnutrition and insulin resistance are especially prominent risk factors for the development of cardiac diastolic dysfunction in females. We recently reported that consumption of a Western diet (WD) containing excess fat (46%), sucrose (17.5%), and high fructose corn syrup (17.5%) for 16 weeks resulted in cardiac diastolic dysfunction and aortic stiffening in young female mice and that these abnormalities were prevented by mineralocorticoid receptor blockade. Herein, we extend those studies by testing whether WD-induced diastolic dysfunction and factors contributing to diastolic impairment, such as cardiac fibrosis, hypertrophy, inflammation, and impaired insulin signaling, are modulated by excess endothelial cell mineralocorticoid receptor signaling. Four-week-old female endothelial cell mineralocorticoid receptor knockout and wild-type mice were fed mouse chow or WD for 4 months. WD feeding resulted in prolonged relaxation time, impaired diastolic septal wall motion, and increased left ventricular filling pressure indicative of diastolic dysfunction. This occurred in concert with myocardial interstitial fibrosis and cardiomyocyte hypertrophy that were associated with enhanced profibrotic (transforming growth factor β1/Smad) and progrowth (S6 kinase-1) signaling, as well as myocardial oxidative stress and a proinflammatory immune response. WD also induced cardiomyocyte stiffening, assessed ex vivo using atomic force microscopy. Conversely, endothelial cell mineralocorticoid receptor deficiency prevented WD-induced diastolic dysfunction, profibrotic, and progrowth signaling, in conjunction with reductions in macrophage proinflammatory polarization and improvements in insulin metabolic signaling. Therefore, our findings indicate that increased endothelial cell mineralocorticoid receptor signaling associated with consumption of a WD plays a key role in the activation of cardiac profibrotic, inflammatory, and growth pathways that lead to diastolic dysfunction in female mice.

Abstract P172: Sex Differences in Obesity Associated Diastolic Dysfunction in Western Diet Fed Mice

Premenopausal women are protected against cardiovascular disease (CVD); however, this protection is lost in the setting of obesity, insulin resistance and type 2 diabetes. The mechanisms responsible for abrogation of the sex-related CVD protection are not clearly understood. We have recently developed a translational model in which female mice fed a diet high in fat and refined carbohydrates (western diet - WD) develop cardiac stiffness and diastolic dysfunction earlier than males consuming a WD. We hypothesized that these earlier adverse effects in females are mediated via increased mineralocorticoid (MR) activation/oxidative stress mediated activation (phosphorylation) of the serine kinase, S6K1 which promotes cardiac growth and fibrosis. Accordingly, four week old male and female C57BL6/J mice were fed a WD (containing high fat [46%], sucrose [17.5%], and high fructose corn syrup [17.5%]) or control diet (CD) for 8 and 16 weeks. Two-dimensional echocardiograms were used to evaluate diastolic function. Immunohistochemistry and western blotting were used to evaluate MR receptor expression and S6K1 phosphorylation. Diastolic dysfunction, indicated by prolonged isovolumic relaxation time (IVRT) and abnormal myocardial performance (increased myocardial performance index [MPI]) was present at 8 weeks in WD-fed female, but not male mice. Although male mice fed a WD exhibited diastolic dysfunction at 16 weeks, diastolic function as assessed by IVRT was more pronounced in female mice. The magnitude of cardiac fibrosis and oxidative stress was greater in females consuming a WD. Moreover, levels of plasma aldosterone, expression of MR (WD female 1.60 fold, WD male 1.26 fold), phosphorylation of S6K1 (WD females 2.92 fold, WD males 1.97 fold) and levels of mRNA for monocyte chemoattractant protein 1 (MCP-1, WD females 1.86 fold, WD males 1.16 fold) were higher in WD-fed female mice compared to WD-fed male mice. These results suggest enhanced cardiac MR mediated S6K1 activation and increased immune and inflammatory responses contribute to enhanced fibrosis and abrogation of cardiac protection in female mice fed a WD high in fat and fructose.

Abstract P233: Sodium Glucose Transporter Type-2 (SGLT-2) Inhibitor, Empagliflozin, Improves Cardiovascular Outcomes in Female Diabetic db/db Mice Independent of Blood Pressure Reduction

Dysglycemia, proteinuria, vascular stiffness, diastolic dysfunction (DD) and hypertension are abnormalities seen more frequently in the obese, diabetic population. SGLT-2 inhibitors (SGLT-2i), which increase urinary glucose/sodium excretion to lower HbA1c and blood pressure (BP), are emerging as unique diabetes therapies. We examined whether the SGLT-2i, empagliflozin (EMPA), ameliorates hypertension, dysglycemia, proteinuria, aortic stiffness and DD in obese/diabetic female db/db mice. Eleven week old mice were fed a diet with or without EMPA (10mg/kg/day) for 5 weeks. In vivo blood pressure (telemetry), diastolic function (echo), aortic stiffness (pulse wave velocity, PWV), proteinuria, renal resistivity (echo) and HbA1c were evaluated. Db/db had elevated BP that was not affected by SGLT2i. HbA1c, proteinuria and the renal resistivity index (RI) were elevated (P<0.001) in control (Db) mice vs treated mice (Db-EMPA) and lean control mice. Db exhibited DD that was ameliorated by SGLT2i as indicated by reduced LV filling pressure (<E/E’) and improved septal wall motion (E’/A’ ratio, not shown). Elevated PWV and aortic endothelial cell stiffness in Db-C were abrogated with SGLT2i. These results show that SGLT2i confers BP-independent cardiovascular and renal protective effects in obese diabetic female mice.

Abstract 131: Endothelial Cell Mineralocorticoid Receptor: A Critical Player in Aortic Stiffness and Cardiac Diastolic Dysfunction in Female Mice

Enhanced activation of mineralocorticoid receptors (MRs) impairs insulin metabolic signaling, increases oxidative stress, and induces maladaptive immune responses with associated CV abnormalities. Emerging information suggests that obesity and insulin resistance predict CV stiffness in females. However, the specific role of endothelial cell MR (ECMR) has not been explored. Accordingly, we hypothesized that ECMR signaling modulated by a western diet (WD) impairs insulin signaling and increases inflammation, fibrosis and CV stiffness in females. Four week-old ECMR knockout (ECMR -/- ) and wild-type female mice were fed a mouse chow or WD containing fat (46%), sucrose (17.5%), and high fructose (17.5%) for 16 weeks. WD prompted MR to bind the hormone response element (nGnACAnnnTGTnCn) on the site of ENaC promoter and induced an increase in ENaC expression that was associated with increased aortic and EC stiffness as determined by in vivo pulse wave velocity and ex vivo atomic force microscopy techniques, respectively The elevated aortic stiffness was accompanied by increased expression of cytokines IL-17, MCP-1 and M1 markers CD 86, and CD11c. ENaC expression was reduced in the ECMR -/- vasculature with a decrease in WD-increase in aortic and EC stiffness.. ECMR -/- also improved aortic vasorelaxation to Ach, SNP (10 -9 -10 -4 mol/L), and insulin (0.1- 300 ng/ml), which were impaired by WD. Additionally, ECMR -/- restored WD-induced cardiac diastolic dysfunction assessed by cardiac MRI and echocardiography. Diastolic dysfunction was related to cardiomyocyte hypertrophy, oxidative stress, and fibrosis and occurred with enhanced activation of S6 kinase-1, Erk 1/2, serine phosphorylation of IRS-1, inactivation of PI3K-AKT-eNOS signaling pathways and the pro-fibrotic TGF-β1/ Smad signaling pathway and increased macrophage pro-inflammatory polarization. ECMR -/- markedly attenuated the cardiac functional and changes signaling induced by WD. These findings suggest that increased ECMR signaling and associated ENaC activation plays a key role in WD induced insulin metabolic sinaling impairment, adaptive pro-inflammatory responses, macrophage polarization and associated aortic stiffness and cardiac diastolic dysfunction in females.

Abstract 112: Endothelial Mineralocorticoid Receptor Knock Out Protects the Endothelium From Aldosterone-Mediated Vascular Stiffness

Background: There is accumulating evidence that increased levels of aldosterone (Aldo) and increased vascular mineralocorticoid receptor (MR) signaling increases vascular inflammation and oxidative stress leading to endothelial dysfunction and associated vascular stiffness. However, the specific role of endothelial cell (EC) MR activation in promotion of end stiffness in female mice has not been explored. Accordingly, we hypothesized that knocking out MR from ECs would attenuate the Aldo-induced endothelial dysfunction and vascular stiffness.

Methods and Results: Twenty six week-old female ECMR knockout (ECMR-/-) and wild type (ECMR+/+) mice were infused with 250 μg/Kg/day Aldo for 3 weeks. To assess endothelial-dependent vasodilation, endothelial and aortic stiffness and blood pressure we utilized wire myography, atomic force microscopy (AFM), pulse wave velocity (PWV) (before and after Aldo perfusion) and tail cuff procedures. Aldo infusion did not increase BP or PWV and this was not affected by the presence or absence of ECMR. Aldo impaired endothelial-dependent vasodilation and increased EC stiffness 8.6 fold and these effects were mitigated in ECMR-/-. Aldo did not alter peri-aortic fibrosis by picrosirius red staining as measured by average gray scale intensities, nor did it cause medial thickening or aortic remodeling evaluated by the lumen to aortic wall ratio, in either Aldo-infused group. Moreover, levels of the oxidative marker, 3-nitrotyrosine (3-NT) did not differ in different compartments of the aortic wall in either Aldo treated group.

Conclusion: ECMR protects the endothelium from aldo-mediated impaired vasodilation and endothelial cell stiffness, and this protection occurs without changes in BP, total aortic stiffness, or vascular remodeling.

Abstract P635: Improvement of Cardiovascular Outcomes in Diabetic Rats by a Novel Angiotensin II Receptor Peptide Agonist

Diabetes Mellitus (DM) is an independent predictor of cardiovascular disease (CVD). Recent reports show that Angiotensin II type 2 receptor (AT2R) promotes cardiac repair after myocardial infarction. Therefore, we hypothesized that activation of AT2R would improve cardiac function in diabetic rats. Male Zucker obese (ZO) rats are leptin receptor–deficient and exhibit hyperphagia, obesity, insulin resistance and hyperlipidemia. They are a widely used rodent model for early stage Type 2 DM (T2DM). We and others have reported that male ZO rats exhibit diastolic and systolic dysfunction. Therefore we investigated whether a two week treatment with an AT2R agonist could improve cardiac functions of young male ZO rats. Thirteen-week old male ZO rats were subjected to daily intraperitoneal injections (0.9mg/kg/day) with a novel peptide AT2R agonist, NP-6A4 (from Novopyxis, Inc.) dissolved in saline (n=7) or saline only (n=6) for two weeks. Conventional echocardiography and speckle tracking strain analysis were performed using a Vevo 2100 (visualsonics) small animal ultrasound system. Fasting (6 hours) plasma analysis showed that triglycerides (mg/dL) were significantly reduced in response to treatment (ZO+ Saline=1229±164; ZO+NP-6A4= 610±109; p<0.015). Importantly, NP-6A4 treatment improved E/E’ ratio (ZO+Saline= 32.3±2.06; ZO+NP-6A4= 26±2.1; p<0.005), which indicates a significant improvement in diastolic dysfunction. A unit rise in the E/E' ratio is associated with a 17% increment in risk of a cardiac event. Moreover, myocardial performance index of NP-6A4 treated rats was also reduced (ZO+ Saline= 0.516±0.03; ZO+ NP-6A4= 0.389±0.02; p<0.006). Finally, circumferential strain (deg/sec) of endocardium (short axis view) was also significantly improved in response to treatment, while no significant changes were observed in radial or longitudinal strains (ZO+ Saline= -20.56±1.65; ZO+ NP-6A4= -26.11±2.47; p<0.024). Collectively, these data suggest that activation of the AT2R by NP-6A4 had significant lipid lowering effect and improved diastolic and systolic functions in diabetic rats.

Abstract P232: Dipeptidyl Peptidase-4 (DPP-4) Inhibitor, Linagliptin, Prevents Aortic Stiffening and Vascular and Cardiac Diastolic Dysfunction Caused by Western Diet Feeding in Female Mice

Aortic stiffness, endothelial dysfunction and diastolic dysfunction (DD) are cardiovascular (CV) abnormalities seen in obesity associated with consumption of high fat/fructose western diet (WD). Moreover, CV dysfunction is increasingly prevalent in obese women. Herein, we examined whether the DPP-4 inhibitor, linagliptin (LINA), improves these outcomes in WD fed female C57BL/6 mice. Four week old mice were fed control diet (CD) or WD with or without LINA for 16 weeks, after which pulse wave velocity (aortic stiffness) (PWV), echocardiography (diastolic function), atomic force microscopy (endothelial stiffness) and wire myography (aortic vascular reactivity) were performed. Compared to CD mice, WD mice exhibited 21% and 353% higher PWV and endothelial stiffness, respectively. WD induced DD, indicated by impaired septal wall motion (<E’/A’ ratio), left atrial filling pressure (>E/Vp ratio), prolonged isovolumic relaxation time (IVRT) and impaired myocardial performance index (>MPI). These vascular and cardiac abnormalities were prevented by LINA. LINA also prevented WD-induced impairments in acetylcholine-, sodium nitroprusside-, and insulin-mediated aortic vascular relaxation. These results show that LINA exerts CV protection in a translational model of obesity.

Abstract P199: Uric Acid Promotes Vascular Stiffness, Immune Inflammatory Response and Proteinuria in Western Diet Fed Mice

Increased consumption of a diet high in fructose and fat (western diet, WD) is associated with an increase in cardiovascular disease (CVD) and kidney injury. In this regard, excess hepatic production of uric acid generated from excess fructose consumption is emerging as a risk factor for vascular stiffness, which underpins CVD and kidney injury. We hypothesized that a WD would increase uric acid levels and cardiovascular and renal xanthine oxidase (XO) activity and associated increased vascular stiffness and proteinuria. Furthermore, we proposed that inhibition of XO activity would prevent arterial stiffening and reduce proteinuria in a clinically relevant model of WD-induced CVD and renal injury. Four week-old C57BL6/J male mice were fed a WD containing high fat (46%), sucrose (17.5%), and high fructose corn syrup (17.5%) with or without allopurinol (125mg/L), a potent XO inhibitor for 16 weeks. XO inhibition significantly attenuated WD-induced increases in plasma and urine uric acid levels and aortic XO activity (WD, 0.225 + 0.031 mU/mL WD + allopurinol, 0.097+ 0.026mU/mL, P<0.05), as well as proteinuria (WD, 20.92 + 2.66 mg/ mg creatinine, WD + allopurinol, 13.48 + 1.56 mg/mg creatinine, P<0.05). XO inhibition had no effect on increases in body weight, fat mass, and HOMA-IR promoted by the WD. Blood pressure was not different between any of the groups. Stiffness of aortic endothelial cells, extracellular matrix and vascular smooth muscle cells, as determined by atomic force microscopy, was significantly increased in WD mice and this was prevented by XO inhibition. WD induced a significant macrophage pro-inflammatory response in aorta that was significantly suppressed by XO inhibition. Collectively, these findings support the notion that increased XO activity in the vasculature and kidney and increased hepatic production of uric acid secondary to consumption of a WD promotes vascular stiffness, vascular inflammation and a maladaptive immune response that lead to vascular stiffness and kidney injury.

Vascular stiffness in insulin resistance and obesity

Obesity, insulin resistance, and type 2 diabetes are associated with a substantially increased prevalence of vascular fibrosis and stiffness, with attendant increased risk of cardiovascular and chronic kidney disease. Although the underlying mechanisms and mediators of vascular stiffness are not well understood, accumulating evidence supports the role of metabolic and immune dysregulation related to increased adiposity, activation of the renin angiotensin aldosterone system, reduced bioavailable nitric oxide, increased vascular extracellular matrix (ECM) and ECM remodeling in the pathogenesis of vascular stiffness. This review will give a brief overview of the relationship between obesity, insulin resistance and increased vascular stiffness to provide a contemporary understanding of the proposed underlying mechanisms and potential therapeutic strategies.