Does the median preoptic nucleus contribute to sympathetic hyperactivity in spontaneously hypertensive rats?

The subfornical organ drives hypertension in polycystic kidney disease via the hypothalamic paraventricular nucleus

AIMS

Hypertension is a prevalent yet poorly understood feature of polycystic kidney disease. Previously we demonstrated that increased glutamatergic neurotransmission within the hypothalamic paraventricular nucleus produces hypertension in the Lewis Polycystic Kidney rat model of polycystic kidney disease. Here we tested the hypothesis that augmented glutamatergic drive to the paraventricular nucleus in Lewis Polycystic Kidney rats originates from the forebrain lamina terminalis, a sensory structure that relays blood-borne information throughout the brain.

METHODS AND RESULTS

Anatomical experiments revealed that 38% of paraventricular nucleus-projecting neurons in the subfornical organ of the lamina terminalis expressed Fos/Fra, an activation marker, in Lewis Polycystic Kidney rats while <1% of neurons were Fos/Fra+ in Lewis control rats (P = 0.01, n = 8). In anaesthetised rats, subfornical organ neuronal inhibition using isoguvacine produced a greater reduction in systolic blood pressure in the Lewis Polycystic Kidney versus Lewis rats (-21 ± 4 vs. -7 ± 2 mmHg, P < 0.01; n = 10), which could be prevented by prior blockade of paraventricular nucleus ionotropic glutamate receptors using kynurenic acid. Blockade of ionotropic glutamate receptors in the paraventricular nucleus produced an exaggerated depressor response in Lewis Polycystic Kidney relative to Lewis rats (-23 ± 4 vs. -2 ± 3 mmHg, P < 0.001; n = 13), which was corrected by prior inhibition of the subfornical organ with muscimol but unaffected by chronic systemic angiotensin II type I receptor antagonism or lowering of plasma hyperosmolality through high-water intake (P > 0.05); treatments that both nevertheless lowered blood pressure in Lewis Polycystic Kidney rats (P < 0.0001).

CONCLUSION

Our data reveal multiple independent mechanisms contribute to hypertension in polycystic kidney disease, and identify high plasma osmolality, angiotensin II type I receptor activation and, importantly, a hyperactive subfornical organ to paraventricular nucleus glutamatergic pathway as potential therapeutic targets.

TRANSLATIONAL PERSPECTIVE

Hypertension is a significant comorbidity for all forms of chronic kidney disease and for individuals with polycystic kidney disease, often an early presenting feature. Nevertheless, the cause(s) of hypertension in polycystic kidney disease are poorly defined. Here we define the contribution of a neural pathway that contributes to hypertension in polycystic kidney disease. Critically, targeting this pathway may provide an additional antihypertensive effect beyond that achieved with current conventional antihypertensive therapies. Future work identifying the drivers of this neural pathway will aid in the development of newer generation antihypertensive medication.

Median preoptic nucleus excitatory neurotransmitters in the maintenance of hypertensive state

The crucial role of the median preoptic nucleus (MnPO) in the maintenance of hydroelectrolytic balance and autonomic regulation have been highlighted. Recently, the participation of the MnPO in the control of sympathetic nerve activity was demonstrated in essential hypertension model. However, peculiarities on the neurochemical changes underlying the differential role of MnPO during hypertension remain to be clarified. Therefore, this study aimed to investigate the main excitatory pathways that modulate MnPO neurons in hypertensive rats. Spontaneously hypertensive rats (SHR) and rats submitted previously to the Goldblatt protocol (two kidneys; one clip; 2K1C) were used. Rats of both groups (250 to 350 g, n = 6) were anesthetized with urethane (1.2 g/kg,i.v.) and instrumented to record mean arterial pressure (MAP), heart rate (HR) and renal sympathetic nerve activity (RSNA). Nanoinjection (100 nl) of saline (NaCl, 150 mM), losartan (AT1 receptor antagonist; 10 mM) and kynurenic acid (glutamate receptor antagonist; 50 mM) into the MnPO were performed. In 2K1C rats, glutamatergic blockade promoted decreases in MAP and RSNA (-19.1 ± 0.9 mmHg, -21.6 ± 2.8%, p < 0.05) when compared to saline (-0.4 ± 0.6 mmHg, 0.2 ± 0.7%, p < 0.05). Angiotensinergic inhibition also reduced these parameters (-11.5 ± 1.2 mmHg, -10.5 ± 1.0%, p < 0.05) in 2K1C. In SHR, Kynurenic acid nanoinjections produced hypotension and sympathoinhibition (-21.0 ± 2.5 mmHg, -24.7 ± 2.4%, p < 0.05), as well losartan nanoinjections (-9.7 ± 1.2 mmHg; p < 0.05) and RSNA (-12.0 ± 2.4%, p < 0.05). These findings support the conclusion that a tonic excitatory neurotransmission exerted by angiotensin II, and mostly by glutamate in the MnPO could participate in the modulation of blood pressure and RSNA independent on whether hypertension is primarily neurogenic or is secondary to stenosis in renal artery.