Endothelium-dependent regulation of the mechanical properties of aortic valve cusps

OBJECTIVES

The aim of this study was to evaluate the role of valve endothelium in regulating the mechanical properties of aortic valve cusps.

BACKGROUND

Mechanical properties of valve cusps are key to their function and durability; however, little is known about the regulation of valve biomechanics.

METHODS

Mechanical properties of porcine aortic valve leaflets were evaluated in response to serotonin (5-hydroxytryptamine [5-HT]), with and without N-nitro-L-arginine-methyl-ester (L-NAME) or endothelial denudation, and endothelin (ET)-1, with and without cytochalasin-B.

RESULTS

Under physiological loading conditions, 5-HT induced a decrease in the areal stiffness of the cusp (-25.0 +/- 4.0%; p < 0.01 vs. control), which was reversed by L-NAME or endothelial denudation (+17.5 +/- 5.3%, p = 0.07, and +14.7 +/- 1.8%, p < 0.05 vs. control, respectively). ET-1 caused an increase in stiffness (+34.4 +/- 13.8%; p < 0.05 vs. control), but not in the presence of cytochalasin-B (p = 0.29 vs. control). Changes in cusp stiffness were accompanied by aortic cusp relaxations to 5-HT (-0.29% +/- 0.1% change in load per 10-fold increase in 5-HT concentration; p = 0.03), which were reversed by endothelial denudation (+0.29 +/- 0.06% change in load per 10-fold increase in 5-HT concentration; p = 0.02) and by L-NAME (p < 0.05). Valve cusps contracted in response to ET-1 (+0.29 +/- 0.08% change in load per 10-fold increase in ET-1 concentration; p = 0.02), which was inhibited by cytochalasin-B.

CONCLUSIONS

These data highlight the role of the endothelium in regulating the mechanical properties of aortic valve cusps and underline the importance of valve cellular integrity for optimal valve function.

Neuronal regulation of aortic valve cusps

Heart valves have long been considered exclusively passive structures that open and close in response to changes in transvalvular pressure during the cardiac cycle. Although this is partly true, recent evidence suggests that valves are far more sophisticated structures. Microscopic examination of heart valves reveals a complex network of endothelial cells, interstitial cells, an extracellular matrix and a rich network of intrinsic nerves. The distribution of these nerve networks varies between the four valves, but is remarkably conserved between species. The present review will focus mainly on aortic valve innervation for several reasons: it is most commonly involved in disease processes, it lies in a unique hemodynamic environment and is exposed to extreme mechanical forces. These nerves are likely to play a significant role in the modulation of aortic valve structure and function and its adaptation to different hemodynamic and humoral conditions. The objectives of this review are first to describe the anatomy of aortic valve innervation, then detail the functional significance of innervation to the valve and finally make the case for the clinical relevance of understanding the neural control of aortic valves and its potential pharmacologic implications.

Localisation and function of nerves in the aortic root

Neural structures have been shown to be present in valve cusp tissue. We aimed to characterise the influence of neuronal stimulation on the component structures of the aortic root and cusps. Specimens of sinus, sinotubular junction (STJ), annulus and cusp tissue were dissected from porcine aortic roots and either stimulated with electrical field stimulation (EFS) in isolated tissue baths or fixed for immunohistochemical characterisation of neuronal structures. Sinus, STJ and annular tissue all gave tetrodotoxin-sensitive, frequency-dependent contractions in response to EFS. Contractions in annular tissue were only evident in tissue from the left- and non-coronary cusps, but not from the right-coronary cusp. Cusp tissue gave no contractile response to EFS, however in the presence of 1 mumol tetrodotoxin a strong contractile response was evident. This contractile response was unmasked when cusp tissue was stimulated in the presence of a nitric oxide synthase or guanylate cyclase inhibitors. Immunohistochemical analysis identified a network of neurofilament positive fibers in tissue from all aortic root structures that were associated with the presence of tyrosine hydroxylase and choline acetyl transferase. The nerve fibers in cusp tissue were in close proximity to the endothelial surface and demonstrated positive staining for neuronal nitric oxide synthase. Nerves in the aortic valve exert a nitric oxide-mediated neurogenic dilator tone in cusp tissue and are capable of producing contractile responses in different components of the aortic root. These responses could influence valve function in health and disease.

Antioxidant Properties of the Internal Thoracic Artery and the Radial Artery

BACKGROUND

The antioxidant properties of blood vessels contribute to their performance and patency of that vessel when used as a bypass conduit. Despite increased use of the radial artery (RA) in recent years, very little is known about its antioxidant properties. We compared the ability of the RA to generate superoxide and assessed its antioxidant protective capacity with that of the internal thoracic artery (ITA).

METHODS

Vascular segments of the ITA and the RA were obtained from patients undergoing coronary artery bypass grafting (CABG) incubated in culture media for 2, 24, 48 and 72 hours. The amount of superoxide generated by each artery, and the deterioration of the endothelial function were assessed by using chemiluminescence (CL) and organ bath techniques. We also assessed the expression, localisation and the activity of superoxide dismutase (SOD) in both arteries; using reverse transcription-polymerase chain reaction (RT-PCR), immunolocalisation techniques and standard biochemical assessment of SOD activity.

RESULTS

Under stress, the RA generated more superoxide (133.6+/-54.7 at 72h vs. 16.8+/-6.4 at 2h; P<0.01) and its endothelial function deteriorated faster (56.3+/-7.3 at 72h vs. 20.2+/-1.5 at 2h; P<0.0001) than that of ITA. Cu/Zn-SOD was found to be prevalent in the endothelium, while Ec-SOD was distributed evenly in the endothelium and media of both arteries. The activity of SOD was less in the RA compared with that of the ITA (510.2+/-219.8 vs. 808.6+/-343.7, respectively; P=0.03).

CONCLUSIONS

Our study shows that the RA is less equipped with an antioxidant protective mechanism compared with the ITA. These findings could partially explain the differential clinical performance of these conduits in CABG.

A novel role of the sympatho-adrenergic system in regulating valve calcification

BACKGROUND

Aortic valve calcification is a progressive process resembling ossification. Recent evidence indicates that the sympathetic nervous system plays an important role in regulating bone deposition and resorption through the beta2-adrenergic receptors (beta2-ARs). The aim of this study is to determine the level and pattern of expression of beta2-ARs in human valve interstitial cells (ICs) and assess their influence on differentiation of the cells into an osteoblast-like phenotype.

METHODS AND RESULTS

Immunohistochemical analysis demonstrated a high expression of beta2-ARs, beta1-ARs, beta3-AR,s and receptor activator of nuclear factor-kappaB (RANK) in calcified aortic valves. The expression of beta2-ARs and beta1-ARs mRNA was assessed by real-time TaqMan PCR in cultures of human aortic valve ICs. Human valve ICs treated with the selective beta2-AR agonist, salmeterol, in the presence of osteogenic medium showed a significant 5-fold decrease in the alkaline phosphatase (ALP) activity in comparison to cells treated with osteogenic medium only (P<0.05). Immunocytochemical staining of the valve ICs showed a concomitant reduction in osteocalcin expression. In addition, other beta2-AR agonists caused a reduction in the protein expression of bone markers including ALP, Cbfa-1, and periostin. Human valve ICs treated with norepinephrine, in the presence of osteogenic medium, did not show a significant reduction in the ALP activity.

CONCLUSIONS

These findings suggest an important role of the beta2-ARs in regulating valve calcification and may identify potential therapeutic targets.

Molecular and functional characteristics of heart-valve interstitial cells

The cells that reside within valve cusps play an integral role in the durability and function of heart valves. There are principally two types of cells found in cusp tissue: the endothelial cells that cover the surface of the cusps and the interstitial cells (ICs) that form a network within the extracellular matrix (ECM) within the body of the cusp. Both cell types exhibit unique functions that are unlike those of other endothelial and ICs found throughout the body. The valve ICs express a complex pattern of cell-surface, cytoskeletal and muscle proteins. They are able to bind to, and communicate with, each other and the ECM. The endothelial cells on the outflow and inflow surfaces of the valve differ from one another. Their individual characteristics and functions reflect the fact that they are exposed to separate patterns of flow and pressure. In addition to providing a structural role in the valve, it is now known that the biological function of valve cells is important in maintaining the integrity of the cusps and the optimum function of the valve. In response to inappropriate stimuli, valve interstitial and endothelial cells may also participate in processes that lead to valve degeneration and calcification. Understanding the complex biology of valve interstitial and endothelial cells is an important requirement in elucidating the mechanisms that regulate valve function in health and disease, as well as setting a benchmark for the function of cells that may be used to tissue engineer a heart valve.

Force generation of different human cardiac valve interstitial cells: relevance to individual valve function and tissue engineering

BACKGROUND AND AIM OF THE STUDY

Cardiac valves perform highly sophisticated functions that depend upon the specific characteristics of the component interstitial cells (ICs). The ability of valve ICs to contribute to these functions may be related to the generation of different types of tension within the valve structure. The study aim was to characterize cellular morphology and the forces generated by valve ICs and to compare this with morphology and forces generated by other cell types.

METHODS

Cultured human valve ICs, pericardial fibroblasts and vascular smooth muscle cells were seeded in 3-D collagen gels and placed in a device that accurately measures the forces generated. Cell morphology was determined in seeded gels fixed in glutaraldehyde, stained with toluidine blue and visualized using a high-definition stereo light microscope.

RESULTS

Valve ICs generated an average peak force of 30.9 +/- 10.4 dynes over a 24-h period which, unlike other cell types tested, increased as cell density decreased (R = 0.67, p <0.0001). The temporal pattern of force generation in mitral valve cells was significantly faster than in aortic or tricuspid cells (p <0.05). Microscopic examination revealed the formation of cellular processes establishing a cell/cell and cell/matrix network. When externally induced changes in matrix tension occurred, the valve ICs unlike the other cell types - did not respond to restore the previous level of tension.

CONCLUSION

Human cardiac valve ICs produce a specific pattern of force generation that may be related to the individual function of each heart valve. The specialized function of these cells may serve as a guide for the choice of candidate cells for tissue engineering heart valves.

Correlation between vascular responsivensss and expression of novel transcripts of the ETA-receptor in human vascular tissue

Alternatively spliced endothelin (ET-1) receptor transcripts have been identified, but their significance to the functional effects of ET-1 has not been established. We have investigated the presence and influence of alternatively spliced ET(A) receptor transcripts on ET-1 mediated contraction of segments of human saphenous vein. The expression of ET(A) receptor transcripts was examined with quantitative reverse transcription-polymerase chain reaction (qPCR) studies, while the response of veins to ET-1 was tested with in vitro organ bath techniques. The expression of four different transcripts for the ET(A) receptor, in which either exon 3 is spliced out (Delta3), exon 4 is spliced out (Delta4), both 3 and 4 spliced out (Delta3,4) and when both exons 2 and 4 (Delta2,4) are spliced out were identified. Functional studies showed that a lack of efficacy and potency of ET-1 is associated with a significantly lower expression of the Delta3,4 transcript. ET(A) receptor antagonism was insurmountable in samples that had lower levels of the Delta3,4 transcript, while samples from patients with higher expression of the Delta3,4 showed surmountable antagonism with BQ123. These results suggest that there is a genetic basis for the variability between individuals for the contractile effect of ET-1 at ET(A) receptors.

Characterization of structural and signaling molecules by human valve interstitial cells and comparison to human mesenchymal stem cells

BACKGROUND AND AIM OF THE STUDY

Human mesenchymal stem cells (MSCs) are a potential cell source for the tissue engineering of biological structures, including cardiac valves. A comprehensive, phenotypic analysis of MSCs and, for the latter, their comparison with valve interstitial cells (ICs) is therefore essential.

METHODS

Isolates of bone marrow-derived human MSCs and human cardiac valve ICs were extensively phenotyped for their expression of membrane proteins involved in adhesion and cell-cell communication, cytoskeletal components, extracellular matrix (ECM) proteins and gene expression of WNT/FZD/SFRP/DKK/LRP family members.

RESULTS

MSCs and valve ICs (>80%) expressed fibroblast surface antigen, smooth muscle alpha-actin, vimentin and CD44; expression of MHC class I and II and calponin was inconsistent, and a small proportion expressed desmin and smooth muscle myosin. CD105 was weakly expressed by a low percentage of valve ICs (<10%) compared to MSCs (>90%). ECM components made by both cell types demonstrated similar levels and patterns of staining, although expression of elastin was not detected by both cell types. Adhesion molecule expression was highly variable among the MSC isolates and between the two cell types, with the predominant integrins being alphal, alpha3, alpha5, and beta1 by both cell types. PCR analysis of WNT/FZD/SFRP/LRP family members revealed a greater range of the WNT family of genes being expressed in MSCs compared to ICs.

CONCLUSION

The study results provided an extensive fingerprint of valve ICs and of MSCs for the tissue engineering of biological structures and for the manipulation of their desired phenotype. MSCs represent a promising cell type for valve tissue engineering, and will require extensive phenotyping after differentiation.

Magnetic Resonance Imaging of Ferumoxide-Labeled Mesenchymal Stem Cells Seeded on Collagen Scaffolds—Relevance to Tissue Engineering

Mesenchymal stem cells (MSCs) are a promising candidate cell for tissue engineering. Magnetic resonance imaging (MRI) has been proven effective in visualizing iron-labeled stem cells; however, the efficiency of this approach for visualization of cells seeded on scaffolds intended for use as tissue-engineered heart valves has not been assessed. MSCs were labeled by incubating for 48 h with ferumoxide and poly-L-lysine as transfecting agent. Any detrimental effect of iron labeling on cell viability, proliferation, and differentiation was examined using appropriate functional assays. Change in the nuclear magnetic relaxation properties of labeled cells was determined using in vitro relaxometry of cells seeded in 3-dimensional collagen gels. Images of labeled and non-labeled cells seeded onto 1% type I bovine collagen scaffolds were obtained using MRI. The presence of intracellular iron in labeled cells was demonstrated using Prussian blue staining, confocal microscopy, and electron microscopy. Cell viability, proliferation, and differentiation were comparable in labeled and non-labeled cells. The T2 relaxation time was 40% to 50% shorter in ferumoxide-labeled cells. Labeled cells seeded on scaffolds appeared as areas of reduced signal intensity in T2 weighted images. Ferumoxide labeling persisted and remained effective even on scans performed 4 weeks after the labeling procedure. Ferumoxide labeling of human MSCs seeded on collagen scaffolds is an effective, non-toxic technique for visualization of these cells using MRI. This technique appears promising for cell tracking in future tissue-engineering applications.

Potential for Synthesis and Degradation of Extracellular Matrix Proteins by Valve Interstitial Cells Seeded onto Collagen Scaffolds

Matrix remodeling, which involves proteolytic enzymes, such as the matrix metalloproteinases (MMPs), is of significant importance with respect to tissue engineering a heart valve construct. The ability of valve interstitial cells (ICs) to release these enzymes in biological scaffolds and to synthesize their own matrix has not been adequately studied, and this has important implications for tissue engineering. Cultured human aortic valve ICs were seeded onto a 3-dimensional type I collagen matrix for 28 days, whereby the presence of the remodeling enzymes, MMPs, were determined using immunohistochemistry, and detection of extracellular matrix (ECM) gene expression was performed using in situ hybridization. The collagenases, stromelysins, and membrane-type MMPs were expressed in 1%, 2%, and 5% collagen scaffolds after 28 days, whereas gelatinase expression was not observed. In situ hybridization revealed the presence of the ECM messenger ribonucleic acid (mRNA) in cells cultured in collagen scaffolds however, an increase in all three mRNAs was only detected in the 1% collagen scaffolds. The presence of collagenases, stromelysins, and membrane-type MMPs indicate that human valve ICs have the capacity to remodel type I collagen scaffold and that the genes necessary for synthesizing matrix have been turned on within the cells themselves. Scaffold composition also demonstrated differential effects onMMPexpression. These observations are of relevance with respect to the development of tissue-engineered heart valves.

Role of human valve interstitial cells in valve calcification and their response to atorvastatin

BACKGROUND

Calcific aortic valve stenosis is a common disease in the elderly and is characterized by progressive calcification and fibrous thickening of the valve, but the cellular and molecular mechanisms are not fully understood. We hypothesized that human valve interstitial cells (ICs) are able to differentiate into osteoblast-like cells through the influence of defined mediators and that this process can be modulated pharmacologically.

METHODS AND RESULTS

To test this hypothesis, we treated primary cultures of human aortic valve ICs with osteogenic media, bone morphogenic proteins ([BMPs] BMP-2, BMP-4, and BMP-7), and tissue growth factor-beta ([TGF-beta] TGF-beta1 and TGF-beta3) for 21 days. These mediators induced osteoblast differentiation of valve ICs by significantly increasing the activity and expression of alkaline phosphatase ([ALP] P<0.001). A cytokine protein array revealed that atorvastatin treatment (100 micromol/L) of human valve ICs caused a downregulation in levels of expression of BMP-2, BMP-6, TGF-beta1, and TGF-beta3 after 24 hours. In addition, human valve ICs treated with atorvastatin in the presence of osteogenic media showed a significant reduction in ALP activity in comparison to cells treated with osteogenic media only (P=<0.001). This was further confirmed with immunocytochemical staining of valve ICs, whereby atorvastatin markedly reduced the expression of ALP and osteocalcin induced by osteogenic media in comparison to untreated cells.

CONCLUSIONS

These findings suggest that human valve ICs are capable of osteoblastic differentiation, by potential mediators which can be pharmacologically targeted by atorvastatin.

A novel role of extracellular nucleotides in valve calcification: a potential target for atorvastatin

BACKGROUND

Calcific aortic valve disease is a common condition and is associated with inflammatory changes and expression of osteoblast-like cell phenotypes, but the cellular mechanisms are unclear. Recent studies identified extracellular ATP and P2Y receptor cascade as important regulators of bone remodeling, whereas its breakdown product, adenosine, is known to have anti-inflammatory properties. We hypothesize that extracellular ATP and adenosine have important roles in regulating osteoblast differentiation in human valve interstitial cells, and that this can be a potential target for therapy. Method and Results- Primary cultures of human valve interstitial cells (ICs) treated for 21 days with osteogenic media, ATP, and ATP-gamma-S (a stable agonist of the P2Y receptor) revealed a significant increase in alkaline phosphatase (ALP) (an osteoblast marker) activity and expression as measured using spectrophotometric assay and immunocytochemistry staining. Valve ICs treated with adenosine alone did not cause an increase in ALP activity; however, adenosine treatment decreased the ALP activity and expression induced by osteogenic media after 21 days of incubation. In addition, atorvastatin inhibited the activity of ALP induced by ATP in human valve ICs, and enzyme studies revealed that atorvastatin upregulated the breakdown of extracellular ATP into adenosine in human valve ICs after 24-hour treatment.

CONCLUSIONS

These findings identify a novel role for extracellular nucleotides in inducing osteoblast differentiation in human valve ICs in vitro and provide a potential therapeutic target for preventing the disease progression.

Expression and localization of C-type natriuretic peptide in human vascular smooth muscle cells

OBJECTIVES

C-type natriuretic peptide (CNP) released by vascular endothelium relaxes smooth muscle and is important in the maintenance of vascular tone. Since it is not known whether other human vascular cell types produce CNP, we investigated its expression in human vascular smooth muscle.

METHODS

CNP expression was examined by RT-PCR in vascular smooth muscle cells (SMC) cultured from human saphenous vein (SV), internal mammary artery (IMA) and radial artery (RA), and CNP protein was probed using immunostaining, in tissue sections and in SMCs cultured from these vessels, respectively.

RESULTS

PCR for CNP produced a 334 bp product in all SMC cultures, as expressed in endothelial cells, although the band intensity was markedly less in SMCs. Myocardium from CNP-knockout mouse did not express CNP, while there was expression in wild-type mouse. CNP protein was detected by immunostaining in 100% of SMC cultures. By immunostaining of tissue sections, CNP was detected throughout the medial layer, but not adventitia, of all vessel types.

CONCLUSIONS

Expression of CNP at gene and protein level by human vascular SMCs suggests that CNP may have the capacity to regulate vascular tone independently of the endothelium.

Interaction of human valve interstitial cells with collagen matrices manufactured using rapid prototyping

Rapid prototyping is a novel process for the production of scaffolds of predetermined size and three-dimensional shape. The aim of the study was to determine the feasibility of this technology for producing scaffolds for tissue engineering an aortic valve and the optimal concentration of collagen processed in this manner that would maintain viability and promote proliferation of human valve interstitial cells. Scaffolds of 1%, 2% and 5% w/v bovine type-I collagen were manufactured using rapid prototyping. Valve interstitial cells isolated from three human aortic valves were seeded on the scaffolds and cultured for up to 4 weeks. Cell viability was assessed using the CellTiter 96 Aq(ueous) One Solution Cell Proliferation Assay and cell death by lactate dehydrogenase (LDH) measurement. Valve interstitial cells remained viable and proliferated within the collagen scaffolds. Cells consistently proliferated to a greater extent on 1% collagen scaffolds rather than either 2% or 5% collagen and after 4 weeks reached 212+/-33.1%, 139+/-25.9% and 129+/-38.3% (mean+/-SD) of their initial seeding density on 1%, 2% and 5% collagen scaffolds, respectively. LDH analysis demonstrated that there was minimal cell death indicating that the collagen scaffold was not toxic to human valve interstitial cells. Rapid prototyping provides a route to optimize biological scaffold designs for tissue engineering cardiac valves. This technology has the versatility to create scaffolds that are compatible with the specific needs of the valve interstitial cells and should enhance cell viability, proliferation and function.

Collagen synthesis by mesenchymal stem cells and aortic valve interstitial cells in response to mechanical stretch

OBJECTIVE

The synthesis of appropriate extracellular matrix by cells in tissue engineered heart valve constructs will be important for the maintenance of valve cusp integrity and function. We have examined and compared the capacity of mesenchymal stem cells to synthesise collagen in response to stretch in comparison with native aortic valve interstitial cells.

METHODS

Cells were stretched on a Flexercell FX4000 apparatus and total collagen synthesis was measured by the incorporation of [3H]-proline. The effect of stretch on gene expression of different collagen types was assessed by RT-PCR.

RESULTS

There was a significant (p<0.01) increase in [3H]-proline incorporation into stretched valve cells at 10%, 14% and 20% stretch. The response of mesenchymal stem cells at 14% stretch was similar to that seen in the valve cells. Incorporation of [3H]-proline into soluble proteins in the cell media was significantly higher (p<0.01) only at 14% and 20% stretch in valve interstitial cells. These effects were shared with mesenchymal stem cells at 14% stretch. RT-PCR experiments demonstrated that 14% stretch up-regulated levels of mRNA for COL3A1 gene (type III collagen) but did not increase the expression of COL1A1 gene (type I collagen) in valve interstitial cells. However, both collagen genes could be detected in non-stretched and stretched mesenchymal stem cells. There was no evidence that the mesenchymal stem cells had started to adopt an osteoblastic cell phenotype in response to stretch.

CONCLUSIONS

Collagen synthesis by valve interstitial cells is dependent upon the degree and duration of stretch. This response can be mimicked closely by exposure of mesenchymal stem cells to the same stretching profile. These properties could have important implications for the choice of cells and programme of conditioning with which to tissue engineer heart valves.

Endothelin-1 and the aortic valve

The aortic valve is a complex structure, the function of which is fundamental to sustain life. Previously believed to be an inert structure that merely opens in response to the forward flow of blood out of the left ventricle, it is now established that it is a sophisticated structure with specific biological properties. However, little is known about the mechanisms that regulate its function. In this respect, endothelin is of particular interest due to its range of biological actions within the cardiovascular system that suggest it may be capable of stimulating the cells that reside in valve cusps. Endothelin can be detected in the endothelial cells that cover valve cusps and it has been demonstrated that it is has the ability to stimulate contractile responses of cusp tissue in vitro. These contractions vary with different regions of the aortic valve cusp and occur preferentially in the circumferential direction. In addition, evidence exists that suggests endothelin may also have a role in the morphogenesis of the aortic valve. Further studies are required to determine the significance of the effects mediated by endothelin on cusp tissue to the function of the aortic valve in health and disease.

C-Type Natriuretic Peptide Relaxes Human Coronary Artery Bypass Grafts Preconstricted by Endothelin-1

BACKGROUND

Endothelin is implicated in graft spasm after coronary artery bypass grafting. We assessed reversal by the endothelium-derived vasodilator C-type natriuretic peptide of prior contraction of radial artery and other vessels commonly used for coronary artery bypass surgery.

METHODS

Segments of human radial artery, saphenous vein, and internal mammary artery were mounted in organ baths after removal from patients undergoing cardiac surgery (n = 34; 64 +/- 2 years). Effects of increasing concentrations of C-type natriuretic peptide (with or without aprotinin, 1,000 U/mL) on endothelin-induced contraction were compared with acetylcholine, sodium nitroprusside, and papaverine.

RESULTS

C-type natriuretic peptide relaxed endothelin precontraction in all vessels (F = 17.8, 36.3, and 48.4, respectively; p < 0.001), with maximum relaxations of 44%, 54%, and 66% in saphenous vein, internal mammary artery, and radial artery, respectively. Aprotinin did not affect relaxation to C-type natriuretic peptide. Acetylcholine relaxed the saphenous vein weakly, with maximal relaxation of 9% at 10(-6) M. However, the radial artery and internal mammary artery relaxed strongly to acetylcholine. The highest concentration of papaverine completely relaxed all vessels, but responses were less sensitive than to sodium nitroprusside or acetylcholine.

CONCLUSIONS

C-type natriuretic peptide reverses endothelin-induced constriction in arterial and venous conduits used for coronary artery bypass, particularly the radial artery. Proteolytic breakdown of C-type natriuretic peptide by local vascular enzymes appears of little importance in vitro. This signals the therapeutic potential of using C-type natriuretic peptide as an antagonist of graft vasospasm after coronary artery bypass surgery.

Expression, localisation and function of ACE and chymase in normal and atherosclerotic human coronary arteries

The expression, localisation and function of enzymes responsible for the local formation of angiotensin II in atherosclerotic and non-atherosclerotic human coronary arteries were studied. Human epicardial coronary arteries expressed mRNA for both ACE and chymase. Immunohistochemical studies revealed that ACE was localised to the vascular endothelium, and to a lesser extent the medial smooth muscle cells, in both large and small arteries. Chymase was detected in both types of vessel but was shown to be associated with mast cells. The contractions to angiotensin I in large arteries were inhibited only by a combination of quinaprilat and soyabean trypsin inhibitor. In the intramyocardial arteries the response to angiotensin I was markedly inhibited in the presence of chymostatin. These findings demonstrate that a dual pathway for the synthesis of angiotensin II is active in diseased and non-diseased coronary arteries.

Differential Effect of Cerivastatin and L-Arginine on the Vascular Function of Human Radial and Left Internal Thoracic Arteries

BACKGROUND

There are a number of strategies to restore/preserve endothelial function. We have compared the effects of Cerivastatin (CS) to those of L-arginine (L-ARG) supplementation on the endothelial function of human arterial grafts.

METHODS

During coronary artery bypass grafting, specimens of radial artery (RA) and left internal thoracic artery (LITA) were obtained. Specimens were divided into vascular rings, which were incubated with either 10(-6) mol/L CS, 10(-3) mol/L L-ARG, or vehicle (control) for 2 or 24 hours. Endothelial function was examined with acethylcholine (10(-9) to 10(-5) mol/L) following contraction by 3 x 10(-8) mol/L endothelin-1.

RESULTS

Although no significant differences were observed in the RA at 2 hours, after 24 hours incubation, endothelium-dependent vasodilatation was significantly higher in CS group (68.4 +/- 5.0%; n = 6) compared to L-ARG group (49.9 +/- 5.4%; n = 7, p < 0.05) and control group (33.8 +/- 2.9%; n = 13, p < 0.0001). In addition, there was a significant increase in L-ARG group compared to control (p < 0.01). After 2 hours incubation of the LITA, CS failed to enhance endothelium-dependent vasodilatation compared to control (44.1 +/- 4.9%; n = 9, vs. 40.0 +/- 5.2%; n = 16, respectively, NS), while L-ARG increased it (64.7 +/- 4.9%; n = 7, p < 0.05 vs. CS and p < 0.01 vs. control). However, this increase disappeared at 24 hours although there was a higher trend of endothelium-dependent vasodilatation in CS group (30.3 +/- 3.7%; n = 8 in L-ARG, 56.5 +/- 8.8%; n = 9 in CS and 41.0 +/- 5.5%; n = 18 in control).

CONCLUSIONS

CS preserved endothelium-dependent vasodilatation of RA greater than L-ARG. These findings suggest that the use of statins may be an effective therapeutic strategy to preserve endothelial function in the RA grafts, and could have important implications in the clinical practice.

ANG II activates effectors of mTOR via PI3-K signaling in human coronary smooth muscle cells

We have previously shown that the vasoconstrictive peptide angiotensin II (ANG II) is a hypertrophic agent for human coronary artery smooth muscle cells (cSMCs), which suggests that it plays a role in vascular wall thickening. The present study investigated the intracellular signal transduction pathways involved in the growth response of cSMCs to ANG II. The stimulation of protein synthesis by ANG II in cSMCs was blocked by the immunosuppressant rapamycin, which is an inhibitor of the mammalian target of rapamycin (mTOR) signaling pathway that includes the 70-kDa S6 kinase (p70(S6k)) and plays a key role in cell growth. The inhibitory effect of rapamycin was reversed by a molar excess of FK506; this indicates that both agents act through the common 12-kDa immunophilin FK506-binding protein. ANG II caused a rapid and sustained activation of p70(S6k) activity that paralleled its phosphorylation, and both processes were blocked by rapamycin. In addition, both of the phosphatidylinositol 3-kinase inhibitors wortmannin and LY-294002 abolished the ANG II-induced increase in protein synthesis, and wortmannin also blocked p70(S6k) phosphorylation. Furthermore, ANG II triggered dissociation of the translation initiation factor, eukaryotic initiation factor-4E, from its regulatory binding protein 4E-BP1, which was also inhibited by rapamycin and wortmannin. In conclusion, we have shown that ANG II activates components of the rapamycin-sensitive mTOR signaling pathway in human cSMCs and involves activation of phosphatidylinositol 3-kinase, p70(S6k), and eukaryotic initiation factor-4E, which leads to activation of protein synthesis. These signaling mechanisms may mediate the growth-promoting effect of ANG II in human cSMCs.

Specific regional and directional contractile responses of aortic cusp tissue

BACKGROUND AND AIM OF THE STUDY

The control of valve size and function is a dynamic process that may be modulated by vasoactive factors. The exact response of different regions of the cusp tissue with regard to extent and direction could influence valve shape, function and response to stress.

METHODS

Porcine aortic valve cusps were cut into either circumferential (basal, belly and coapting edge) or radial (left, center and right) strips. Together with an intact cusp orientated circumferentially, specimens were set up in isolated organ baths.

RESULTS

In response to 90 mM KCI, the belly of the cusp (0.66 +/- 0.05 mN; p <0.05) was significantly more responsive than either the basal region (0.41 +/- 0.06 mN) or the coapting edge (0.31 +/- 0.03 mN) and all three regions of radially orientated strips (left: 0.13 +/- 0.02 mN; center: 0.23 +/- 0.04 mN; right: 0.11 +/- 0.03 mN). All strips showed contraction to endothelin-1 (10(-9) to 10(-7) M). When corrected for weight, the responses of the basal (15.2 +/- 1.8 mN/g) and belly (11.3 +/- 1.5 mN/g) regions were significantly greater than that of the coapting edge (8.4 +/- 1.0 mN/g; p <0.05) and the intact cusp (7.1 +/- 1.9 mN/g, n = 7, p <0.05). In the radially orientated tissue, responses to endothelin-1 were similar in all three regions (left: 3.4 +/- 1.0 mN/g; center: 3.2 +/- 0.5 mN/g; right: 2.3 +/- 0.9 mN/g).

CONCLUSION

The contractile ability of valve cusps occurs preferentially in the circumferential direction. The enhanced contraction of the basal region may have important implications for the management of stresses experienced by the hinge of the valve. In addition, these findings may be relevant in designing tissue for valve repair by cusp extension or for the tissue engineering of a whole valve.