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Wang D, Zhu ZL, Lin DC, Zheng SY, Chuang KH, Gui LX, Yao RH, Zhu WJ, Sham JSK, Lin MJ. Magnesium Supplementation Attenuates Pulmonary Hypertension via Regulation of Magnesium Transporters. Hypertension 2020; 77:617-631. [PMID: 33356397 DOI: 10.1161/hypertensionaha.120.14909] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary hypertension (PH) is characterized by profound vascular remodeling and altered Ca2+ homeostasis in pulmonary arterial smooth muscle cells (PASMCs). Magnesium ion (Mg2+), a natural Ca2+ antagonist and a cofactor for numerous enzymes, is crucial for regulating diverse cellular functions, but its roles in PH remains unclear. Here, we examined the roles of Mg2+ and its transporters in PH development. Chronic hypoxia and monocrotaline induced significant PH in adult male rats. It was associated with a reduction of [Mg2+]i in PASMCs, a significant increase in gene expressions of Cnnm2, Hip14, Hip14l, Magt1, Mmgt1, Mrs2, Nipa1, Nipa2, Slc41a1, Slc41a2 and Trpm7; upregulation of SLC41A1, SLC41A2, CNNM2, and TRPM7 proteins; and downregulation of SLC41A3 mRNA and protein. Mg2+ supplement attenuated pulmonary arterial pressure, right heart hypertrophy, and medial wall thickening of pulmonary arteries, and reversed the changes in the expression of Mg2+ transporters. Incubation of PASMCs with a high concentration of Mg2+ markedly inhibited PASMC proliferation and migration, and increased apoptosis, whereas a low level of Mg2+ produced the opposite effects. siRNA targeting Slc41a1/2, Cnnm2, and Trpm7 attenuated PASMC proliferation and migration, but promoted apoptosis; and Slc41a3 overexpression also caused similar effects. Moreover, siRNA targeting Slc41a1 or high [Mg2+] incubation inhibited hypoxia-induced upregulation and nuclear translocation of NFATc3 in PASMCs. The results, for the first time, provide the supportive evidence that Mg2+ transporters participate in the development of PH by modulating PASMC proliferation, migration, and apoptosis; and Mg2+ supplementation attenuates PH through regulation of Mg2+ transporters involving the NFATc3 signaling pathway.
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Affiliation(s)
- Dan Wang
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.,Department of Physiology and Pathophysiology (D.W., Z.-L.Z., D.-C.L., K.-H.C., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Zhuang-Li Zhu
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.,Department of Physiology and Pathophysiology (D.W., Z.-L.Z., D.-C.L., K.-H.C., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Da-Cen Lin
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.,Department of Physiology and Pathophysiology (D.W., Z.-L.Z., D.-C.L., K.-H.C., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Si-Yi Zheng
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Kun-Han Chuang
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Long-Xin Gui
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Ru-Hui Yao
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.,Department of Physiology and Pathophysiology (D.W., Z.-L.Z., D.-C.L., K.-H.C., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Wei-Jie Zhu
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.,Department of Physiology and Pathophysiology (D.W., Z.-L.Z., D.-C.L., K.-H.C., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - James S K Sham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (J.S.K.S.)
| | - Mo-Jun Lin
- From the Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, (D.W., Z.-L.Z., D.-C.L., S.-Y.Z., K.-H.C., L.-X.G., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.,Department of Physiology and Pathophysiology (D.W., Z.-L.Z., D.-C.L., K.-H.C., R.-H.Y., W.-J.Z., M.-J.L.), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
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Ahmed A, Sayed AH, Elkholy J, Elshal S, Badwy A, Abdelhamid B, Ollaek M. Intraoperative MgSO 4 infusion protects oxygenation and lung mechanics in COPD patients during general anesthesia. A randomized clinical trial. Acta Anaesthesiol Scand 2020; 64:1460-1468. [PMID: 32770840 DOI: 10.1111/aas.13684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The purpose of this study was to examine the effects of an intraoperative MgSO4 infusion on arterial oxygenation and lung mechanics in patients with moderate COPD undergoing cancer larynx surgery under general anesthesia (GA). Our primary outcome was arterial oxygenation determined by the PaO2 and PaO2 /FiO2 . The secondary outcomes were lung mechanics (peak airway pressure, airway plateau pressure, dead space, lung compliance, airway resistance) and postoperative complications. METHODS In this randomized controlled double-blinded trial, 40 patients with an ASA classifications II and/or III who were diagnosed with moderate COPD and who were scheduled for cancer larynx surgery under GA were randomly allocated into two equal groups, the target (Mg group) and control group (C group). In the Mg group, 30 mg/kg of 10% MgSO4 solution was administered intravenously for over 20 minutes as the loading dose, followed by the continuous infusion of 10 mg/kg/hr In the C group, the same loading and maintenance infusion rates were administered using 0.9% saline. RESULTS Unlike the C group (baseline "T0" to post-infusion "T1" interval 294 ± 97 vs 238 ± 71 mm Hg, respectively, P = .04 ± SD), the Mg group exhibited preserved intraoperative PaO2 (T0 to T1 interval 271 ± 89 vs 257 ± 53 mm Hg, respectively, P = .54 ± SD) and PaO2 /FiO2 (C group T0 to T1 interval 404 ± 81 vs 349 ± 84, P = .04 and Mg group 394 ± 91 vs 379 ± 95, P = .61, respectively), and these effects were modest. Further, compared to the C group, the Mg group exhibited lower airway resistance, dead space, airway plateau pressure, and peak airway pressure, and higher dynamic compliance. The postoperative PaO2 and PaO2 /FiO2 were higher in the Mg group compared to the C group. CONCLUSIONS Intraoperative infusion of MgSO4 in patients with moderate COPD undergoing laryngectomy surgery under GA produces mild perioperative protective effects on both arterial oxygenation and lung mechanics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03461328; registration date: 8 March 2018.
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Affiliation(s)
- Abeer Ahmed
- Department of Anesthesiology Surgical ICU and Pain Management Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
| | - Ahmed H. Sayed
- Department of Anesthesiology Surgical ICU and Pain Management Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
| | - Jehan Elkholy
- Department of Anesthesiology Surgical ICU and Pain Management Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
| | - Sahar Elshal
- Department of Anesthesiology Surgical ICU and Pain Management Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
| | - Abdelrahman Badwy
- Department of Otorhinolaryngology Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
| | - Bassant Abdelhamid
- Department of Anesthesiology Surgical ICU and Pain Management Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
| | - Mohamed Ollaek
- Department of Anesthesiology Surgical ICU and Pain Management Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt
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Mu YP, Huang QH, Zhu JL, Zheng SY, Yan FR, Zhuang XL, Sham JSK, Lin MJ. Magnesium attenuates endothelin-1-induced vasoreactivity and enhances vasodilatation in mouse pulmonary arteries: Modulation by chronic hypoxic pulmonary hypertension. Exp Physiol 2018; 103:604-616. [PMID: 29363240 DOI: 10.1113/ep086655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/17/2018] [Indexed: 12/28/2022]
Abstract
NEW FINDINGS What is the central question of this study? The central goal of this study was to elucidate the role of magnesium in the regulation of pulmonary vascular reactivity in relationship to hypoxic pulmonary hypertension. What is the main finding and its importance? We found that magnesium is essential for normal vasoreactivity of the pulmonary artery. Increasing the magnesium concentration attenuates vasoconstriction and improves vasodilatation via release of nitric oxide. Pulmonary hypertension is associated with endothelial dysfunction resulting in the suppression of magnesium modulation of vasodilatation. These results provide evidence that magnesium is important for the modulation of pulmonary vascular function. ABSTRACT Pulmonary hypertension (PH) is characterized by enhanced vasoreactivity and sustained pulmonary vasoconstriction, arising from aberrant Ca2+ homeostasis in pulmonary arterial (PA) smooth muscle cells. In addition to Ca2+ , magnesium, the most abundant intracellular divalent cation, also plays crucial roles in many cellular processes that regulate cardiovascular function. Recent findings suggest that magnesium regulates vascular functions by altering the vascular responses to vasodilator and vasoactive agonists and affects endothelial function by modulating endothelium-dependent vasodilatation in hypertension. Administration of magnesium also decreased pulmonary arterial pressure and improved cardiac output in animal models of PH. However, the role of magnesium in the regulation of pulmonary vascular function related to PH has not been studied. In this study, we examined the effects of magnesium on endothelin-1 (ET-1)-induced vasoconstriction, ACh-induced vasodilatation and the generation of NO in PAs of normoxic mice and chronic hypoxia (CH)-treated mice. Our data showed that removal of extracellular magnesium suppressed vasoreactivity of PAs to both ET-1 and ACh. A high concentration of magnesium (4.8 mm) inhibited ET-1-induced vasoconstriction in endothelium-intact or endothelium-disrupted PAs of normoxic and CH-treated mice, and enhanced the ACh-induced production of NO in PAs of normoxic mice. Moreover, magnesium enhanced ACh-induced vasodilatation in PAs of normoxic mice, and the enhancement was completely abolished after exposure to CH. Hence, in this study we demonstrated that increasing the magnesium concentration can attenuate the ET-1-induced contractile response and improve vasodilatation via release of NO from the endothelium. We also demonstrated that chronic exposure to hypoxia can cause endothelial dysfunction resulting in suppression of the magnesium-dependent modulation of vasodilatation.
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Affiliation(s)
- Yun-Ping Mu
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Qiu-Hong Huang
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Jie-Ling Zhu
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Si-Yi Zheng
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Fu-Rong Yan
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Xiao-Ling Zhuang
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - James S K Sham
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mo-Jun Lin
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
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