Skeletal muscle microvasculature response to β-adrenergic stimuli is diminished with cardiac surgery

Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction

Despite significant advances in surgical technique and strategies for tissue/organ protection, cardiac surgery involving cardiopulmonary bypass is a profound stressor on the human body and is associated with numerous intraoperative and postoperative collateral effects across different tissues and organ systems. Of note, cardiopulmonary bypass has been shown to induce significant alterations in microvascular reactivity. This involves altered myogenic tone, altered microvascular responsiveness to many endogenous vasoactive agonists, and generalized endothelial dysfunction across multiple vascular beds. This review begins with a survey of in vitro studies that examine the cellular mechanisms of microvascular dysfunction following cardiac surgery involving cardiopulmonary bypass, with a focus on endothelial activation, weakened barrier integrity, altered cell surface receptor expression, and changes in the balance between vasoconstrictive and vasodilatory mediators. Microvascular dysfunction in turn influences postoperative organ dysfunction in complex, poorly understood ways. Hence the second part of this review will highlight in vivo studies examining the effects of cardiac surgery on critical organ systems, notably the heart, brain, renal system, and skin/peripheral tissue vasculature. Clinical implications and possible areas for intervention will be discussed throughout the review.

Assessments of microvascular function in organ systems

Microvascular disease plays critical roles in the dysfunction of all organ systems, and there are many methods available to assess the microvasculature. These methods can either assess the target organ directly or assess an easily accessible organ such as the skin or retina so that inferences can be extrapolated to the other systems and/or related diseases. Despite the abundance of exploratory research on some of these modalities and their possible applications, there is a general lack of clinical use. This deficiency is likely due to two main reasons: the need for standardization of protocols to establish a role in clinical practice or the lack of therapies targeted toward microvascular dysfunction. Also, there remain some questions to be answered about the coronary microvasculature, as it is complex, heterogeneous, and difficult to visualize in vivo even with advanced imaging technology. This review will discuss novel approaches that are being used to assess microvasculature health in several key organ systems, and evaluate their clinical utility and scope for further development.

Effects of neuropeptide Y on the microvasculature of human skeletal muscle

BACKGROUND

Neuropeptide Y acts directly on the vasculature as a cotransmitter with norepinephrine for an augmented contraction. Little, however, is known about the effects of neuropeptide Y on the microvasculature of human skeletal muscle. Neuropeptide Y signaling has not been studied in the setting of cardiac surgery and cardiopulmonary bypass. We investigated the role of neuropeptide Y signaling on vasomotor tone in the microvessels of human skeletal muscle, as well as the effect of cardiopulmonary bypass on neuropeptide Y-induced responsiveness.

METHODS

Specimens taken from intercostal muscles were collected from patients, pre- and post-cardiopulmonary bypass, undergoing coronary artery bypass grafting or cardiac valve surgery (n = 8/group). Microvessels (157 ± 47 microns) were isolated in vitro in a no-flow state. Arterial microvascular responses to a neuropeptide Y agonist, a Y1 receptor antagonist, phenylephrine, and the coadministration of neuropeptide Y and phenylephrine were examined. The abundance and localization of the Y1 receptor were measured using Western blot and immunofluorescence, respectively.

RESULTS

Arterial microvessels showed responsiveness to the neuropeptide Y agonist (10^-9 to 4 × 10^-7 mol/L) both before and after cardiopulmonary bypass, reaching a 12.5% vasoconstriction from the baseline luminal diameter. With administration of the Y1 receptor antagonist after neuropeptide Y, the contractile response was eliminated (n = 3/group, P = .04). No difference in vasoconstriction was observed between pre- and post-cardiopulmonary bypass groups (P = .73). The coadministration of neuropeptide Y and phenylephrine (10^-9 to 10^-4 mol/L) elicited no difference in vasoconstriction (n = 7/group, P = .06 both pre- and post-cardiopulmonary bypass) when compared with phenylephrine alone (10^-9 to 10^-4 mol/L). No change in the protein expression or localization of the Y1 receptor was detected by Western blotting (n = 6/group, P = .44) or immunofluorescence (n = 6/group, P = .13).

CONCLUSION

Neuropeptide Y induced vasoconstriction, suggesting that neuropeptide Y may play an important role in the regulation of the peripheral microvasculature. There was no change in microvascular responsiveness to neuropeptide Y after cardiopulmonary bypass nor were there any synergistic effects of neuropeptide Y on phenylephrine-induced vasoconstriction in the skeletal muscle microvasculature.