Basal release of nitric oxide from aortic rings is greater in female rabbits than in male rabbits: implications for atherosclerosis

Control and consequences of endothelial nitric oxide formation

The intention of this chapter is to give a brief overview of the continuously expanding field of endothelium-derived NO. Over the past few years it has become apparent that the mechanisms controlling the activation of NOS are more complex than was previously thought, with factors such as pHi, [Ca2+]i, shear stress, and gender all contributing to the control of "basal" NO production as well as the regulation of NOS levels in endothelial cells. The list of the functional consequences of endothelial NO formation has also grown, with antiproliferative, antihypertensive, and antiatherogenic effects all being described. Recent advances at the molecular biology level have facilitated the pioneering of a whole new field of research, and a number of groups have shown that NO can modulate the expression of several genes, such as that encoding MCP-1, an effect that is probably due to an interaction between NO and transcription factors. Further elucidation of the signals that influence the production and actions of NO will, without doubt, further the understanding of numerous physiological and pathophysiological processes.

Vascular responses to 17 beta-oestradiol in postmenopausal women

The vascular responses to 17 beta-oestradiol were examined in 23 postmenopausal women (59 +/- 7 years [mean +/- SD]) using a placebo-controlled double-blind crossover design. All women received 1 mg 17 beta-oestradiol or placebo (P) sublingually on consecutive days in random order. Axial diameters and blood flow rates of the left common femoral arteries were determined before and 60-80 min after application of verum or placebo as well as 10-30 min after 10 mg isosorbide dinitrate (ISDN) with a quantitative duplex ultrasound technique. Oestradiol induced a vasodilation of femoral arteries (+6.4 +/- 4.1% of basal, P < 0.001 vs. basal and P), the vessel diameter was unchanged with placebo (+0.7 +/- 2.1%). The blood flow rate increased significantly after oestradiol application (+30 +/- 28%, P < 0.05 vs. basal and P), but not after placebo (+11 +/- 21%). Mean blood pressure and heart rate remained constant with both drugs. Despite its vasodilatory effect, ISDN significantly reduced the arterial blood flow after pretreatment with oestradiol and placebo, probably through cardiac preload reduction. In conclusion, 17 beta-oestradiol alters the vascular tone of systemic arteries resulting in a vasodilation and increase of blood flow. We suggest that these direct vascular actions may contribute to the preventive properties of oestrogens on cardiovascular diseases in postmenopausal women.

Chelation of copper reduces inhibition by oxidized lipoproteins of endothelium-dependent relaxation in porcine coronary arteries

We examined the effect of dialyzing oxidized low-density lipoprotein (oLDL) against Krebs-Ringer solution, in the absence (yielding d-oLDL) or presence (yielding EDTA-oLDL) of ethylenediamine tetraacetic acid (EDTA), to investigate the mechanism that underlies the inhibition of endothelium-dependent relaxation (EDR) by o-LDL. Oxidation of LDL by exposure to Cu2+ resulted in the formation of a thiobarbituric acid-reacting substance (TBARS) and lipid hydroperoxide (LPO). At a concentration of 5 mg/dl, d-oLDL markedly attenuated EDR in the porcine coronary artery. Analysis of d-oLDL by gel filtration revealed that TBARS was ditributed in both the lipoprotein and the aqueous phases, whereas LPO was present only in the lipoprotein particles. Lysophosphatidylcholine (LPC), which has been suggested to be responsible for the impairment of EDR by oLDL, was present not only in the lipoprotein but also in the aqueous phase. However, EDR inhibitory activity was observed only in the oLDL particles, not in the aqueous phase. Almost all Cu2+ associated with the oLDL particles was removed by dialysis of oLDL against Krebs-Ringer solution containing EDTA. EDTA-oLDL or native LDL, at concentrations as high as 75 mg/dl, exerted only a moderate inhibitory action on EDR, Both TBARS and LPO in EDTA-oLDL were distributed only in the lipoprotein particles, not in the aqueous phase. These results demonstrate that the impairment of EDR by oLDL is related both to LPO and to transition metal ions such as Cu2+ associated with the lipoprotein particles, not to the amount of the TBARS or negative charge, and that factors other than LPC may affect EDR.

Paradoxes of body fluid volume regulation in health and disease. A unifying hypothesis

The body's normal homeostasis is maintained by the integrity of the excretory capacity of the kidneys. In advanced cardiac failure, however, the avidity of the renal sodium and water retention contributes to the occurrence of pulmonary congestion and peripheral edema. In patients with advanced cirrhosis, the kidneys again fail to excrete the amounts of sodium and water ingested, thus leading to ascites and peripheral edema. The signals for this renal retention of sodium and water in a patient with cirrhosis must be extrarenal because when the same kidneys are transplanted into persons with normal liver function, renal sodium and water retention no longer occurs; rather, the kidneys maintain normal fluid and electrolyte balance. Excessive sodium and water retention by the kidneys also occurs during pregnancy despite a 30% to 50% increase in plasma volume, cardiac output, and glomerular filtration rate. What are the afferent and efferent signals whereby normal kidneys retain sodium and water so that total extracellular, interstitial, and intravascular volumes expand far beyond those limits observed in normal subjects? These dilemmas are the subject of this review, in which a "unifying hypothesis of body fluid volume regulation" is presented.

Nitric oxide accounts for dose-dependent estrogen-mediated coronary relaxation after acute estrogen withdrawal

BACKGROUND

Estrogen replacement therapy reduces the risk of coronary heart disease in postmenopausal women, and estrogen treatment modulates endothelium-dependent vasodilation in ovariectomized, atherosclerotic monkeys. Estradiol-17 beta also induces relaxation in isolated rabbit coronary arteries as well as cerebral basilar arteries. The estrogen concentrations required to induce such relaxation are in the pharmacological range (10(-6) to 10(-5) mol/L).

METHODS AND RESULTS

The present study was designed to test whether the sensitivity and specificity of the relaxing response of coronary vascular smooth muscle to exogenous estradiol-17 beta is dependent on the sex hormone status of the animal. In coronary artery rings contracted with PGF2 alpha (3 x 10(-5) mol/L), estradiol-17 beta caused significant relaxation at a physiological estrogen concentration (10(-9) mol/L), in coronary artery rings from oophorectomized, estrogen-treated and acutely estrogen-withdrawn rabbits only. Relaxation induced by estradiol-17 beta at lower concentrations (10(-9) to 10(-6) mol/L) in these rings was 20 +/- 6%, 42 +/- 8%, 54 +/- 9%, and 75 +/- 8%, respectively, compared with 4 +/- 2%, 12 +/- 5%, 16 +/- 7%, and 25 +/- 12% and 5 +/- 2%, 12 +/- 5%, 18 +/- 8%, and 23 +/- 10% in rings from estrogen-maintained and oophorectomized rabbits, respectively (P < .01). The relaxation in coronary artery rings from estrogen-treated and acutely estrogen-withdrawn rabbits was endothelium and nitric oxide dependent since it was abolished by endothelium removal and the nitric oxide synthase inhibitor N omega-nitro-L-arginine.

CONCLUSIONS

This study demonstrates that estrogen-induced, endothelium-dependent relaxation of coronary arteries may, in some species, depend on the sex hormone status of the animal. These findings may help to better understand the effects of ovarian steroids in the coronary circulation of females.

Induction of nitric oxide synthases early in pregnancy

OBJECTIVE

We have previously demonstrated that calcium-dependent nitric oxide synthase is induced by estrogen and that by the end of pregnancy nitric oxide synthase of both endothelial and neuronal origin is increased in various maternal tissues. This rise in activity may be crucial for the alterations in muscle activity necessary for a successful pregnancy. If so, the increase in nitric oxide synthase activity must occur early in gestation.

STUDY DESIGN

We tested the hypothesis that pregnancy increases nitric oxide synthase activity early in gestation by measuring in heart, kidney, skeletal muscle, and esophagus of time-mated guinea pigs the conversion by nitric oxide synthase of carbon 14-labeled L-arginine to carbon 14-labeled citrulline and the concentration of cyclic guanosine monophosphate, the second messenger of nitric oxide.

RESULTS

Calcium-dependent nitric oxide synthase activity was increased twofold to fourfold by pregnancy in each tissue examined. The rise began by 0.14 gestation (9 of 63 +/- 2 days) and reached a plateau by 0.30 gestation (19 days), which was then maintained until term. The treatment of pregnant animals with tamoxifen decreased nitric oxide synthase activity to nonpregnant values in the heart, where tamoxifen is an estrogen receptor antagonist, but not in kidney, skeletal muscle, and esophagus. Cyclic guanosine monophosphate also rose progressively in each tissue studied until about 0.70 gestation before declining in skeletal muscle, kidney, and heart. It remained elevated in the esophagus.

CONCLUSION

These studies demonstrate that nitric oxide synthase activity in maternal tissues rises early in pregnancy and is associated with an increase in cyclic guanosine monophosphate, the second messenger of nitric oxide. These findings are consistent with the hypothesis that an increase in nitric oxide synthase plays a role in smooth muscle adaptations of pregnancy.

Sex differences in endothelial function in normal and hypercholesterolaemic subjects

Acetylcholine stimulates endothelial synthesis of nitric oxide from L-arginine. To investigate the influence of sex on endothelial function, we measured vasodilator responses to brachial artery administration of acetylcholine in hypercholesterolaemic and control men and women. Mean response to acetylcholine was impaired (55% of that in controls at 15 micrograms/min) in hypercholesterolaemic men but not in hypercholesterolaemic women. L-arginine normalised responses to acetylcholine in hypercholesterolaemic men, but had similar effects in hypercholesterolaemic and control women. These results suggest that women are protected against adverse effects of hypercholesterolaemia on the L-arginine/nitric-oxide pathway.

Induction of calcium-dependent nitric oxide synthases by sex hormones

We have examined the effects of pregnancy and sex hormones on calcium-dependent and calcium-independent nitric oxide synthases (NOSs) in the guinea pig. Pregnancy (near term) caused a > 4-fold increase in the activity of calcium-dependent NOS in the uterine artery and at least a doubling in the heart, kidney, skeletal muscle, esophagus, and cerebellum. The increase in NOS activity in the cerebellum during pregnancy was inhibited by the estrogen-receptor antagonist tamoxifen. Treatment with estradiol (but not progesterone) also increased calcium-dependent NOS activity in the tissues examined from both females and males. Testosterone increased calcium-dependent NOS only in the cerebellum. No significant change in calcium-independent NOS activity was observed either during pregnancy or after the administration of any sex hormone. Both pregnancy and estradiol treatment increased the amount of mRNAs for NOS isozymes eNOS and nNOS in skeletal muscle, suggesting that the increases in NOS activity result from enzyme induction. Thus both eNOS and nNOS are subject to regulation by estrogen, an action that could explain some of the changes that occur during pregnancy and some gender differences in physiology and pathophysiology.

17 beta-estradiol preserves endothelial vasodilator function and limits low-density lipoprotein oxidation in hypercholesterolemic swine

BACKGROUND

Cardiovascular events are less prevalent in premenopausal women and women receiving estrogen replacement than in postmenopausal women or men. Endothelium-derived relaxing factor (EDRF) is an important local modulator of vascular tone, and abnormal endothelial function is related, in part, to the oxidative modification of low-density lipoprotein (LDL). Estrogens possess substantial antioxidant activity and inhibit LDL modification in vitro.

METHODS AND RESULTS

We investigated the effects of 17 beta-estradiol (E2) on endothelial vasomotor function in cholesterol-fed miniature swine. Animals underwent ovariectomy or a sham procedure and received E2 or placebo via implant yielding three groups: sham, ovariectomy (E2 placebo), and implant (E2 implant). After 16 weeks, coronary arteries were harvested and endothelial function was examined in vitro. Vessels from the sham and implant groups demonstrated preserved endothelium-dependent relaxation to bradykinin, substance P, and A23187. Vessels from the ovariectomy group exhibited impaired relaxation to bradykinin and substance P (P < .05 versus sham and implant groups) but not to A23187. Plasma E2 levels were strongly correlated with the response to bradykinin (R = .82, P < .001), substance P (R = .64, P < .01), and A23187 (R = .65, P < .01). Compared with the ovariectomy group, LDL derived from the sham and implant groups was markedly resistant to ex vivo oxidation (P < .05), and this effect correlated with preserved endothelium-dependent relaxation to bradykinin (R = .62, P < .03) and substance P (R = .61, P < .03).

CONCLUSIONS

Thus, E2 preserves endothelial function in cholesterol-fed swine in association with protection of LDL against oxidative modification. These data suggest that E2 may, in part, favorably affect vascular function and coronary artery disease by virtue of its antioxidant properties.