The effect of metabolic inhibition on rat uterine intracellular pH and its role in contractile failure

Human myometrial artery function and endothelial cell calcium signalling are reduced by obesity: Can this contribute to poor labour outcomes?

AIMS

Determining how obesity affects function in human myometrial arteries, to help understand why childbirth has poor outcomes in obese women.

METHODS

Myometrial arteries were studied from 84 biopsies. Contraction (vasopressin and U-46619) and relaxation (carbachol, bradykinin, SNAP) was assessed using wire myography. eNOS activity was assessed using L-NAME. Cholesterol was reduced using methyl-β-cyclodextrin to determine whether it altered responses. Differences in endothelial cell intracellular Ca²⁺ signalling were assessed using confocal microscopy.

RESULTS

The effects of BMI on relaxation were agonist specific and very marked; all vessels, irrespective of BMI, relaxed to bradykinin but 0% of vessels (0/13) from obese women relaxed to carbachol, compared to 59% (10/17) from normal weight women. Cholesterol-lowering drugs did not restore carbachol responses (n = 6). All vessels, irrespective of BMI, relaxed when NO was directly released by SNAP (n = 19). Inhibition of eNOS with L-NAME had a significant effect in normal but not overweight/obese vessels. Compared to bradykinin, a lower proportion of endothelial cells responded to carbachol and the amplitude of the calcium response was significantly less, in all vessels. Furthermore, a significantly lower proportion of endothelial cells responded to carbachol in the overweight/obese group compared to control. In contrast to relaxation, the effect of contractile agonists was unchanged with increasing BMI.

CONCLUSIONS

The ability of human myometrial arteries to relax is significantly impaired with obesity, and our data suggest this is due to a deficit in endothelial calcium signalling. This inability to recover following compression during contractions, might contribute to poor labours in obese women.

Insights into the uterus

A better understanding of the mechanisms that generate and modulate uterine contractility is needed if progress is to be made in the prevention or treatment of problems in labour. Dysfunctional labour describes the condition when uterine contractility is too poor to dilate the cervix, and it is the leading cause of emergency Caesarean sections. Recently, insight has been gained into a possible causal mechanism for dysfunctional labour. Study of the physiological mechanisms that produce excitation in the uterus, the subsequent Ca(2)(+) signals and biochemical pathway leading to contraction has underpinned this progress. In this review, I give an account of excitation-contraction signalling in the myometrium and explore the implications of recent findings concerning lipid rafts for these processes. I also discuss how changes of pH are fundamentally enmeshed in uterine activity and biochemistry and explore the effect that pH changes will have on human myometrium. Finally, I present the evidence that acidification of the myometrium is correlated with dysfunctional labour and suggest the processes by which it is occurring. It is only by gaining a better understanding of uterine physiology and pathophysiology that progress will be made and research findings translated into clinical benefit for women and their families.

Hydrogen peroxide and superoxide anion modulate pregnant human myometrial contractility

Reactive oxygen species (ROS) have the propensity to cause macromolecular damage with consequent modification of cellular function. We investigated the effects of two particular oxidants, superoxide (O2−) anions and hydrogen peroxide (H2O2), on oxytocin-induced myometrial contractility using biopsies from women undergoing Caesarean section at term gestation. Isometric tension recordings were performed and concentration–response curves derived after addition of test agents. A maximal reduction in myometrial contractility to 27.2 ± 4.5% of control was observed followed application of H2O2. The enzyme scavenger catalase (CAT) reduced the inhibitory effect of H2O2but had little effect at 10-fold lower concentrations. Addition of dialysed xanthine oxidase ± hypoxanthine significantly inhibited contractility to 23.8.0 ± 4.2% compared with control. Pre-incubation with superoxide dismutase and CAT diminished this effect. The non-specific potassium channel blocker, tetraethylammonium chloride (1 mM), had no effect on myometrial contractility. We conclude that human myometrium is susceptible to the effects of ROS, which may be produced by reperfusion–ischaemic episodes during labour. Our findings could, in part, explain the weak or prolonged depression of contractions characteristic of myometrial dysfunction culminating in difficult labours.

Long-term hypoxia alters calcium regulation in near-term ovine myometrium

Previous studies showed that long-term hypoxia (LTH) during pregnancy alters myometrial contractility. The present study was designed to test the hypothesis that LTH during pregnancy suppresses myometrial contractility in sheep by affecting the calcium signaling cascade. Pregnant sheep were maintained at high altitude (3820 m) from Day 30 to Day 139 of gestation, when the animals were killed for collection of myometrial tissue. Tissue was also collected from age-matched, normoxic controls. Circular and longitudinal layers were separated, and strips from each layer were mounted in a muscle bath. After pretreatment with 10(-8) M oxytocin, the strips were exposed to increasing half- or quarter-log doses of nifedipine (L-type calcium-channel blocker), ruthenium red, ryanodine (blockers of inositol 1,4,5-trisphosphate-insensitive calcium stores), or 2-nitro-4-carboxyphenyl-N,N-diphenylcarbamate (NCDC; phospholipase C inhibitor). Area under the contraction curve was analyzed, and pD(2) (log of concentration yielding 50% of maximum response) values and maximum relaxation responses were calculated. The maximum relaxation response to nifedipine was increased in both longitudinal (P < 0.01) and circular (P < 0.05) myometrial layers from LTH compared to control tissue, whereas no difference was observed in response to ruthenium red or ryanodine. The maximum relaxation response to NCDC was lower in the LTH circular layer (P < 0.05). Together, these data are indicative of an increase in the dependence of ovine uterine smooth muscle on extracellular calcium influx through the L-type, voltage-gated calcium channels following LTH. This appears to occur not through an increase in L-type calcium channels but, rather, through a possible decline in importance of the oxytocin-induced, phospholipase C-mediated pathway, resulting in a greater proportion of extracellular calcium contributing to contraction. Layer-dependent differences also exist between the circular and longitudinal myometrium in response to phospholipase C inhibition.

A novel model for the in vivo monitoring of uterine microcirculation and intracellular free calcium changes in rat

The aim of this work was to develop a model to study the microcirculation and relative levels of intracellular free calcium in the myometrium of pregnant rats. On Day 21 of gestation a lobe of uterus was prepared free, flipped over, and mounted in a superfusion chamber leaving the radix and thereby the innervation and circulation intact. RBC velocity and arteriolar diameters were determined by means of intravital video microscopy before and after stimulation (norepinephrine). To study intracellular free calcium changes, the fluorescent dye Indo-1 AM was added to the superfusate in the chamber. Fluorescence images were recorded and ratios of the images collected at 400 and 506 nm were calculated and changes thereof were assumed to represent intracellular free calcium changes. RBC velocity and arteriolar diameter did not change for at least 1 h, while the response to norepinephrine was similar at the beginning of the experiment and after 120 min. In four separate interventions, the uterus was challenged with 5 x 10(-4) IU/ml oxytocin, 4.5 mM calcium, 5 x 10(-4) IU/ml oxytocin with 4.5 mM calcium, and 5 microM ionomycin, resulting in an increase of the 400/506 nm ratio of 27, 31, 76, and 103%, respectively, representing a relative increase in intracellular free calcium. This novel in vivo model is suitable for monitoring intracellular free calcium changes and to record RBC velocities and blood vessel diameters in the myometrium of pregnant rats.

In vivo pH and metabolite changes during a single contraction in rat uterine smooth muscle

1. We have used 31P NMR spectroscopy to measure metabolites and pHi at three periods during a phasic contraction of the uterus, in vivo, to determine whether they change as a consequence of contraction. The regular uterine contractions were recorded via a balloon catheter in the uterine lumen. Each phasic contraction was divided into three parts: the period between contractions (rest), the development of force (up) and the relaxation of force (down). The NMR data were summed separately from each of these three periods over 20-40 successive contractions. 2. Significant changes in ATP, phosphocreatine (PCr) and inorganic phosphate (Pi) occurred during the contraction. [ATP] fell from 2.0 to 1.6 mM and [PCr] from 2.6 to 2.0 mM during the up period, while [Pi] increased from 2.2 to 2.8 mM. Recovery of ATP and PCr occurred during the relaxation part of the contraction, whereas Pi did not fully recover until the contraction was complete. 3. Significant acidification from pH 7.28 +/- 0.02 at rest to 7.16 +/- 0.02, occurred with contraction. This acidification is greater than that previously reported for in vitro uterine preparations. Measurements of uterine blood flow show that it decreased with contraction. Therefore, ischaemia, in addition to the metabolic consequences of contraction, may account for the larger acidification observed in vivo. 4. Lowering pHi in an in vitro uterine preparation by a similar level to that found in vivo produced a significant reduction of the phasic contractions. Thus we propose that these changes, especially the fall in pHi during force development, feed back negatively on the contraction to limit its strength, and may help prevent uterine ischaemia and fetal hypoxia during labour.

Mechanisms of hypoxic vasodilatation of isolated rat mesenteric arteries: a comparison with metabolic inhibition

1. Hypoxia (PO2 < 5 mmHg) decreased vessel tone in isolated rat mesenteric arteries precontracted with either high [K+] or the thromboxane analogue U46619. This response was not altered by N-nitro-L-arginine (L-NA) and indomethacin. 2. Simultaneous measurement of pHi and tension showed that the decrease in vessel tone was accompanied by an intracellular acidification. Similar reductions in tone and pHi were observed with the metabolic inhibitors 2,4-dinitrophenol (DNP) and sodium azide. 3. The presence of the lactate transport inhibitor alpha-cyano-4-hydroxy-cinnamic acid (CHC) increased the magnitude of the acidification and resulted in a significantly faster reduction in tone in response to hypoxia. Addition of CHC to normoxic tissues caused both a vasodilatation and a reduction of pHi. 4. A decrease in pHi induced on washout of ammonium chloride (NH4Cl) resulted in an increase in tone. 5. Relaxation to hypoxia or metabolic inhibition was unaffected when the change in pHi was neutralized by addition of the weak base trimethylamine (TMA). 6. It is concluded that severe hypoxia decreases tone in isolated rat mesenteric arteries by a mechanism which is independent of nitric oxide and prostaglandins. Both severe hypoxia and metabolic inhibition reduced pHi, although this does not appear to be contributing to the changes in tone observed.

Hypoxia and smooth muscle function: key regulatory events during metabolic stress

Hypoxia rapidly reduces force in many smooth muscles and we review recent data that shed light on the mechanisms involved. As many regulated cellular processes are integrated to co-ordinate smooth muscle contractility, the processes responsible for decreased force output with altered metabolism are also likely to be many, acting in concert, rather than the actions of one altered parameter. Nevertheless the aim of this study is to elucidate the hierarchical series of events that contribute to reduced smooth muscle force production during altered metabolism. We conclude that in many phasic smooth muscles the decrease in force can be attributed to impaired electro-mechanical coupling whereby the Ca2+ transient is reduced. A direct effect of hypoxia on the Ca2+ channel may be of key importance. In tonic vascular smooth muscles KATP channels may also play a role in the integrated functional responses to hypoxia. There are also many examples of force being reduced, in tonically activated preparations, without a fall in steady-state Ca2+; indeed it usually increases. We examine the roles of altered [ATP], pH, myosin phosphorylation, inorganic phosphate and proteolytic activity on the [Ca2+]-force relationship during hypoxia. We find no defining force-inhibitory role for any one factor acting alone, and suggest that force most probably falls as a result of the combination of myriad factors.

Consequences of metabolic inhibition in smooth muscle isolated from guinea-pig stomach

1. In smooth muscle isolated from the guinea-pig stomach, cyanide (CN) and iodoacetic acid (IAA) were applied to block oxidative phosphorylation and glycolysis, respectively. Effects of IAA on generation of spontaneous mechanical and electrical activities were systematically investigated by comparing those of CN. Spontaneous activity ceased in 10-20 min during applications of 1 mM IAA. On the other hand, application of 1 mM CN also reduced the spontaneous activity, but never terminated it. In the presence of CN the negativity of the resting membrane potential was slightly reduced. 2. When spontaneous activity ceased with IAA, the resting membrane potential was not significantly affected. Also, before ceasing, the amplitude and duration of the spontaneous electrical activity were significantly reduced. The amplitude of the electrotonic potential was, however, not changed by IAA. Further, glibenclamide did not prevent the effects of IAA. These results suggest that, unlike cardiac muscle, activation of metabolism-dependent K+ channels in stomach smooth muscle does not seem to play a major role in reducing and terminating spontaneous activity during metabolic inhibition. 3. Carbachol-induced contraction transiently increased, and subsequently decreased gradually during application of IAA. 4. After 50 min application of IAA, when there was no spontaneous activity, the concentrations of phosphocreatine (PCr) and ATP measured with 31P nuclear magnetic resonance decreased to 60 and 80% of the control, respectively, while inorganic phosphate (Pi) concentration paradoxically fell to below detectable levels. During subsequent prolonged application of IAA, high-energy phosphates steadily decreased. On the other hand, after 50 min CN application, [PCr] and [ATP] decreased to approximately 30 and 80% of the control, respectively, while [Pi] increased by 2.6-fold. 5. In the presence of either CN or IAA, spontaneous mechanical and electrical activities were reduced or eliminated, although amounts of high-energy phosphates sufficient to contract smooth muscle remained. It can be postulated that some mechanism(s) related to energy metabolism, but not including ATP-sensitive K+ channels, plays an important role in generating spontaneous activity in guinea-pig stomach smooth muscle. During metabolic inhibition the energy metabolism-dependent mechanism(s) would preserve high-energy phosphates, and consequently cell viability, by stopping spontaneous activity.

Effect of metabolic inhibition on intracellular Ca2+, phosphorylation of myosin regulatory light chain and force in rat smooth muscle

1. The effect of the inhibition of oxidative phosphorylation on intracellular calcium concentration ([Ca2+]i), phosphorylation of the 20 kDa regulatory light chain of myosin (MLC20) and contractility was investigated in isolated longitudinal smooth muscle from rat uteri. 2. Cyanide (2 mM) application to normally polarized preparations resulted in an elevation of basal [Ca2+]i but an inhibition of [Ca2+]i transients and the accompanying contractions. 3. Depolarization with high-K+ solution (40 mM KCI) resulted in elevation of [Ca2+]i and maintained force production. Phosphorylation of MLC20 was transiently increased followed by a steady-state augmentation above resting levels. 4. Carbachol (100 microM) produced a transient elevation of [Ca2+]i and force of depolarized tissues followed by a steady-state augmentation of both parameters. PGF2 alpha (1 microM) did not significantly potentiate [Ca2+]i or force in depolarized preparations. Both carbachol and PGF2 alpha potentiated phosphorylation of MLC20 in depolarized tissues. 5. Addition of cyanide to depolarized preparations, in the presence or absence of carbachol or PGF2 alpha, resulted in significant attenuation of force under each condition. The magnitude and normalized rates of force inhibition by cyanide were not significantly different for each stimulus condition. MLC20 phosphorylation levels were unaltered by cyanide treatment. However, cyanide increased the maintained level of [Ca2+]i under each experimental protocol. 6. It is concluded that the inhibition of oxidative phosphorylation with cyanide results in dissociation of both the [Ca2+]i-force and MLC20 phosphorylation-force relationships in rat uterine smooth muscle.