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Domínguez-Vías G, Segarra AB, Ramírez-Sánchez M, Prieto I. The Type of Fat in the Diet Influences Regulatory Aminopeptidases of the Renin-Angiotensin System and Stress in the Hypothalamic-Pituitary-Adrenal Axis in Adult Wistar Rats. Nutrients 2021; 13:nu13113939. [PMID: 34836194 PMCID: PMC8625891 DOI: 10.3390/nu13113939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Prolonged feeding with a high-fat diet (HFD) acts as a stressor by activating the functions of the hypothalamic-pituitary-adrenal gland (HPA) stress axis, accompanied of hypertension by inducing the renin-angiotensin-aldosterone system. Angiotensinases enzymes are regulatory aminopeptidases of angiotensin metabolism, which together with the dipeptidyl peptidase IV (DPP-IV), pyroglutamyl- and tyrosyl-aminopeptidase (pGluAP, TyrAP), participate in cognitive, stress, metabolic and cardiovascular functions. These functions appear to be modulated by the type of fat used in the diet. (2) Methods: To analyze a possible coordinated response of aminopeptidases, their activities were simultaneously determined in the hypothalamus, adenohypophysis and adrenal gland of adult male rats fed diets enriched with monounsaturated (standard diet (S diet) supplemented with 20% virgin olive oil; VOO diet) or saturated fatty acids (diet S supplemented with 20% butter and 0.1% cholesterol; Bch diet). Aminopeptidase activities were measured by fluorimetry using 2-Naphthylamine as substrates. (3) Results: the hypothalamus did not show differences in any of the experimental diets. In the pituitary, the Bch diet stimulated the renin-angiotensin system (RAS) by increasing certain angiotensinase activities (alanyl-, arginyl- and cystinyl-aminopeptidase) with respect to the S and VOO diets. DPP-IV activity was increased with the Bch diet, and TyrAP activity decrease with the VOO diet, having both a crucial role on stress and eating behavior. In the adrenal gland, both HFDs showed an increase in angiotensinase aspartyl-aminopeptidase. The interrelation of angiotensinases activities in the tissues were depending on the type of diet. In addition, correlations were shown between angiotensinases and aminopeptidases that regulate stress and eating behavior. (4) Conclusions: Taken together, these results support that the source of fat in the diet affects several peptidases activities in the HPA axis, which could be related to alterations in RAS, stress and feeding behavior.
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Affiliation(s)
- Germán Domínguez-Vías
- Unit of Physiology, Department of Health Sciences, University of Jaén, Las Lagunillas, 23071 Jaén, Spain; (A.B.S.); (M.R.-S.)
- Department of Physiology, Faculty of Health Sciences, Ceuta, University of Granada, 18071 Granada, Spain
- Correspondence: (G.D.-V.); (I.P.); Tel.: +34-953-212008 (I.P.)
| | - Ana Belén Segarra
- Unit of Physiology, Department of Health Sciences, University of Jaén, Las Lagunillas, 23071 Jaén, Spain; (A.B.S.); (M.R.-S.)
| | - Manuel Ramírez-Sánchez
- Unit of Physiology, Department of Health Sciences, University of Jaén, Las Lagunillas, 23071 Jaén, Spain; (A.B.S.); (M.R.-S.)
| | - Isabel Prieto
- Unit of Physiology, Department of Health Sciences, University of Jaén, Las Lagunillas, 23071 Jaén, Spain; (A.B.S.); (M.R.-S.)
- Correspondence: (G.D.-V.); (I.P.); Tel.: +34-953-212008 (I.P.)
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Dong Z, Dai H, Feng Z, Liu W, Gao Y, Liu F, Zhang Z, Zhang N, Dong X, Zhao Q, Zhou X, Du J, Liu B. Mechanism of herbal medicine on hypertensive nephropathy (Review). Mol Med Rep 2021; 23:234. [PMID: 33537809 PMCID: PMC7893801 DOI: 10.3892/mmr.2021.11873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
Hypertensive nephropathy is the most common complication of hypertension, and is one of the main causes of end-stage renal disease (ESRD) in numerous countries. The basic pathological feature of hypertensive nephropathy is arteriolosclerosis followed by renal parenchymal damage. The etiology of this disease is complex, and its pathogenesis is mainly associated with renal hemodynamic changes and vascular remodeling. Despite the increased knowledge on the pathogenesis of hypertensive nephropathy, the current clinical treatment methods are still not effective in preventing the development of the disease to ESRD. Herbal medicine, which is used to relieve symptoms, can improve hypertensive nephropathy through multiple targets. Since there are few clinical studies on the treatment of hypertensive nephropathy with herbal medicine, this article aims to review the progress on the basic research on the treatment of hypertensive nephropathy with herbal medicine, including regulation of the renin angiotensin system, inhibition of sympathetic excitation, antioxidant stress and anti-inflammatory protection of endothelial cells, and improvement of obesity-associated factors. Herbal medicine with different components plays a synergistic and multi-target role in the treatment of hypertensive nephropathy. The description of the mechanism of herbal medicine in the treatment of hypertensive nephropathy will contribute towards the progress of modern medicine.
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Affiliation(s)
- Zhaocheng Dong
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P.R. China
| | - Haoran Dai
- Shunyi Branch, Beijing Traditional Chinese Medicine Hospital, Beijing 101300, P.R. China
| | - Zhandong Feng
- Beijing Chinese Medicine Hospital Pinggu Hospital, Beijing 101200, P.R. China
| | - Wenbin Liu
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
| | - Yu Gao
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
| | - Fei Liu
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P.R. China
| | - Zihan Zhang
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P.R. China
| | - Na Zhang
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
| | - Xuan Dong
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
| | - Qihan Zhao
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
| | - Xiaoshan Zhou
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P.R. China
| | - Jieli Du
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P.R. China
| | - Baoli Liu
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P.R. China
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Méndez-Couz M, Manahan-Vaughan D, Silva AP, González-Pardo H, Arias JL, Conejo NM. Metaplastic contribution of neuropeptide Y receptors to spatial memory acquisition. Behav Brain Res 2020; 396:112864. [PMID: 32827566 DOI: 10.1016/j.bbr.2020.112864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022]
Abstract
Neuropeptide Y (NPY) is highly abundant in the brain and is released as a co-transmitter with plasticity-related neurotransmitters such as glutamate, GABA and noradrenaline. Functionally, its release is associated with appetite, anxiety, and stress regulation. NPY acting on Y2 receptors (Y2R), facilitates fear extinction, suggesting a role in associative memory. Here, we explored to what extent NPY action at Y2R contributes to hippocampus-dependent spatial memory and found that dorsal intrahippocampal receptor antagonism improved spatial reference memory acquired in a water maze in rats, without affecting anxiety levels, or spontaneous motor activity. Water maze training resulted in an increase of Y2R, but not Y1R expression in the hippocampus. By contrast, in the prefrontal cortex there was a decrease in Y2R, and an increase of Y1R expression. Our results indicate that neuropeptide Y2R are significantly involved in hippocampus-dependent spatial memory and that receptor expression is dynamically regulated by this learning experience. Effects are consistent with a metaplastic contribution of NPY receptors to cumulative spatial learning.
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Affiliation(s)
- Marta Méndez-Couz
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, Spain; Ruhr University Bochum, Medical Faculty, Dept. Neurophysiology, Bochum, Germany.
| | | | - Ana Paula Silva
- Laboratory of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine and Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - Héctor González-Pardo
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, Spain
| | - Jorge Luis Arias
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, Spain
| | - Nélida María Conejo
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, Spain
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de Juan A, Ince LM, Pick R, Chen CS, Molica F, Zuchtriegel G, Wang C, Zhang D, Druzd D, Hessenauer MET, Pelli G, Kolbe I, Oster H, Prophete C, Hergenhan SM, Albrecht U, Ripperger J, Montanez E, Reichel CA, Soehnlein O, Kwak BR, Frenette PS, Scheiermann C. Artery-Associated Sympathetic Innervation Drives Rhythmic Vascular Inflammation of Arteries and Veins. Circulation 2019; 140:1100-1114. [PMID: 31401849 DOI: 10.1161/circulationaha.119.040232] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of acute cardiovascular complications is highly time-of-day dependent. However, the mechanisms driving rhythmicity of ischemic vascular events are unknown. Although enhanced numbers of leukocytes have been linked to an increased risk of cardiovascular complications, the role that rhythmic leukocyte adhesion plays in different vascular beds has not been studied. METHODS We evaluated leukocyte recruitment in vivo by using real-time multichannel fluorescence intravital microscopy of a tumor necrosis factor-α-induced acute inflammation model in both murine arterial and venous macrovasculature and microvasculature. These approaches were complemented with genetic, surgical, and pharmacological ablation of sympathetic nerves or adrenergic receptors to assess their relevance for rhythmic leukocyte adhesion. In addition, we genetically targeted the key circadian clock gene Bmal1 (also known as Arntl) in a lineage-specific manner to dissect the importance of oscillations in leukocytes and components of the vessel wall in this process. RESULTS In vivo quantitative imaging analyses of acute inflammation revealed a 24-hour rhythm in leukocyte recruitment to arteries and veins of the mouse macrovasculature and microvasculature. Unexpectedly, although in arteries leukocyte adhesion was highest in the morning, it peaked at night in veins. This phase shift was governed by a rhythmic microenvironment and a vessel type-specific oscillatory pattern in the expression of promigratory molecules. Differences in cell adhesion molecules and leukocyte adhesion were ablated when disrupting sympathetic nerves, demonstrating their critical role in this process and the importance of β2-adrenergic receptor signaling. Loss of the core clock gene Bmal1 in leukocytes, endothelial cells, or arterial mural cells affected the oscillations in a vessel type-specific manner. Rhythmicity in the intravascular reactivity of adherent leukocytes resulted in increased interactions with platelets in the morning in arteries and in veins at night with a higher predisposition to acute thrombosis at different times as a consequence. CONCLUSIONS Together, our findings point to an important and previously unrecognized role of artery-associated sympathetic innervation in governing rhythmicity in vascular inflammation in both arteries and veins and its potential implications in the occurrence of time-of-day-dependent vessel type-specific thrombotic events.
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Affiliation(s)
- Alba de Juan
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Louise Madeleine Ince
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.).,University of Geneva, Centre Médical Universitaire (CMU), Department of Pathology and Immunology, Switzerland (L.M.I., F.M., C.W., G.P., B.R. K., C.S.)
| | - Robert Pick
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Chien-Sin Chen
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Filippo Molica
- University of Geneva, Centre Médical Universitaire (CMU), Department of Pathology and Immunology, Switzerland (L.M.I., F.M., C.W., G.P., B.R. K., C.S.)
| | - Gabriele Zuchtriegel
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Chen Wang
- University of Geneva, Centre Médical Universitaire (CMU), Department of Pathology and Immunology, Switzerland (L.M.I., F.M., C.W., G.P., B.R. K., C.S.)
| | - Dachuan Zhang
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research and Department of Cell Biology, Albert Einstein College of Medicine, New York (D.Z., C.P., P.S.F.)
| | - David Druzd
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Maximilian E T Hessenauer
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Graziano Pelli
- University of Geneva, Centre Médical Universitaire (CMU), Department of Pathology and Immunology, Switzerland (L.M.I., F.M., C.W., G.P., B.R. K., C.S.)
| | - Isa Kolbe
- Institute of Neurobiology, University of Lübeck, Germany (I.K., H.O.)
| | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Germany (I.K., H.O.)
| | - Colette Prophete
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research and Department of Cell Biology, Albert Einstein College of Medicine, New York (D.Z., C.P., P.S.F.)
| | - Sophia Martina Hergenhan
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Urs Albrecht
- University of Freiburg, Switzerland (U.A., J.R.)
| | | | - Eloi Montanez
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Christoph A Reichel
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.)
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention (IPEK), Ludwig Maximilian University, Munich, Germany (O.S.).,Department of Physiology and Pharmacology (FyFa) and Department of Medicine, Karolinska Institutet, Stockholm, Sweden (O.S.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (O.S., C.S.)
| | - Brenda R Kwak
- University of Geneva, Centre Médical Universitaire (CMU), Department of Pathology and Immunology, Switzerland (L.M.I., F.M., C.W., G.P., B.R. K., C.S.)
| | - Paul S Frenette
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research and Department of Cell Biology, Albert Einstein College of Medicine, New York (D.Z., C.P., P.S.F.)
| | - Christoph Scheiermann
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, BioMedical Centre, Planegg-Martinsried, Germany (A.d.J., L.M.I., R.P., C.-S.C., G.Z., D.D., M.E.T.H., S.M.H., E.M., C.A.R., C.S.).,University of Geneva, Centre Médical Universitaire (CMU), Department of Pathology and Immunology, Switzerland (L.M.I., F.M., C.W., G.P., B.R. K., C.S.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (O.S., C.S.)
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Järve A, Todiras M, Kny M, Fischer FI, Kraemer JF, Wessel N, Plehm R, Fielitz J, Alenina N, Bader M. Angiotensin-(1-7) Receptor Mas in Hemodynamic and Thermoregulatory Dysfunction After High-Level Spinal Cord Injury in Mice: A Pilot Study. Front Physiol 2019; 9:1930. [PMID: 30687131 PMCID: PMC6336833 DOI: 10.3389/fphys.2018.01930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/21/2018] [Indexed: 01/12/2023] Open
Abstract
Spinal cord injury (SCI) above mid-thoracic levels leads to autonomic dysfunction affecting both the cardiovascular system and thermoregulation. The renin-angiotensin system (RAS) which is a potent regulator of blood pressure, including its novel beneficial arm with the receptor Mas could be an interesting target in post-SCI hemodynamics. To test the hypothesis that hemodynamics, activity and diurnal patterns of those are more affected in the Mas deficient mice post-SCI we used a mouse model of SCI with complete transection of spinal cord at thoracic level 4 (T4-Tx) and performed telemetric monitoring of blood pressure (BP) and heart rate (HR). Our data revealed that hypothermia deteriorated physiological BP and HR control. Preserving normothermia by keeping mice at 30°C prevented severe hypotension and bradycardia post-SCI. Moreover, it facilitated rapid return of diurnal regulation of BP, HR and activity in wild type (WT) mice. In contrast, although Mas deficient mice had comparable reacquisition of diurnal HR rhythm, they showed delayed recovery of diurnal rhythmicity in BP and significantly lower nocturnal activity. Exposing mice with T4-Tx (kept in temperature-controlled cages) to 23°C room temperature for one hour at different time-points post-SCI, demonstrated their inability to maintain core body temperature, Mas deficient mice being significantly more impaired than WT littermates. We conclude that Mas deficient mice were more resistant to acute hypotension, delayed nocturnal recovery, lower activity and more severely impaired thermoregulation. The ambient temperature had significant effect on hemodynamics and, thus it should be taken into account when assessing cardiovascular parameters post-SCI in mice.
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Affiliation(s)
- Anne Järve
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research, Berlin, Germany
| | - Mihail Todiras
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Melanie Kny
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Falk I Fischer
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralph Plehm
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jens Fielitz
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Greifswald, German Centre for Cardiovascular Research, Greifswald, Germany.,Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Natalia Alenina
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research, Berlin, Germany
| | - Michael Bader
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Institute of Biology, University of Lübeck, Lübeck, Germany
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6
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Wagoner AL, Shaltout HA, Fortunato JE, Diz DI. Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options. Am J Physiol Heart Circ Physiol 2016; 310:H416-25. [PMID: 26608337 PMCID: PMC4888538 DOI: 10.1152/ajpheart.00583.2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/23/2015] [Indexed: 12/31/2022]
Abstract
Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10-18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.
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Affiliation(s)
- Ashley L Wagoner
- Neuroscience Graduate Program, Wake Forest Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hossam A Shaltout
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John E Fortunato
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Debra I Diz
- Neuroscience Graduate Program, Wake Forest Graduate School of Arts and Sciences, Winston-Salem, North Carolina; Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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