Effects of diabetes and uremia on mesenteric vascular reactivity

Nitric Oxide Resistance Reduces Arteriovenous Fistula Maturation in Chronic Kidney Disease in Rats

Background

Autologous arteriovenous (AV) fistulas are the first choice for vascular access but have a high risk of non-maturation due to insufficient vessel adaptation, a process dependent on nitric oxide (NO)-signaling. Chronic kidney disease (CKD) is associated with oxidative stress that can disturb NO-signaling. Here, we evaluated the influence of CKD on AV fistula maturation and NO-signaling.

Methods

CKD was established in rats by a 5/6^th nephrectomy and after 6 weeks, an AV fistula was created between the carotid artery and jugular vein, which was followed up at 3 weeks with ultrasound and flow assessments. Vessel wall histology was assessed afterwards and vasoreactivity of carotid arteries was studied in a wire myograph. The soluble guanylate cyclase (sGC) activator BAY 60–2770 was administered daily to CKD animals for 3 weeks to enhance fistula maturation.

Results

CKD animals showed lower flow rates, smaller fistula diameters and increased oxidative stress levels in the vessel wall. Endothelium-dependent relaxation was comparable but vasorelaxation after sodium nitroprusside was diminished in CKD vessels, indicating NO resistance of the NO-receptor sGC. This was confirmed by stimulation with BAY 60–2770 resulting in increased vasorelaxation in CKD vessels. Oral administration of BAY 60–2770 to CKD animals induced larger fistula diameters, however; flow was not significantly different from vehicle-treated CKD animals.

Conclusions

CKD induces oxidative stress resulting in NO resistance that can hamper AV fistula maturation. sGC activators like BAY 60–2770 could offer therapeutic potential to increase AV fistula maturation.

Excisional wound healing is delayed in a murine model of chronic kidney disease

Background

Approximately 15% of the United States population suffers from chronic kidney disease (CKD), often demonstrating an associated impairment in wound healing. This study outlines the development of a surgical murine model of CKD in order to investigate the mechanisms underlying this impairment.

Methods

CKD was induced in mice by partial cauterization of one kidney cortex and contralateral nephrectomy, modifying a previously published technique. After a minimum of 6-weeks, splinted, dorsal excisional wounds were created to permit assessment of wound healing parameters. Wounds were harvested on postoperative days (POD) 0, 3, 7, and 14 for histological, immunofluorescent, and quantitative PCR (qPCR).

Results

CKD mice exhibited deranged blood chemistry and hematology profiles, including profound uremia and anemia. Significant decreases in re-epithelialization and granulation tissue deposition rates were found in uremic mice wounds relative to controls. On immunofluorescent analysis, uremic mice demonstrated significant reductions in cellular proliferation (BrdU) and angiogenesis (CD31), with a concurrent increase in inflammation (CD45) as compared to controls. CKD mice also displayed differential expression of wound healing-related genes (VEGF, IL-1β, eNOS, iNOS) on qPCR.

Conclusions

These findings represent the first reported investigation of cutaneous healing in a CKD animal model. Ongoing studies of this significantly delayed wound healing phenotype include the establishment of renal failure model in diabetic strains to study the combined effects of CKD and diabetes.

Uterine artery function in a mouse model of pregnancy complicated by diabetes

It has been demonstrated previously that endothelium-dependent vasodilatation is impaired in myometrial arteries from women with gestational diabetes, which may play a role in mediating complications observed in diabetic pregnancies. It is not known which aspects of endothelium-dependent vasodilatation are impaired, thus a mouse model of pregnancy complicated by streptozotocin-induced diabetes was established to investigate underlying mechanisms. Uterine arteries from term-pregnant, diabetic and control C57Bl6/J mice were assessed using acetylcholine (ACh; 10(-10)-10(-5)M) in the presence or absence of a nitric oxide (NO) synthase inhibitor (L-NNA; 10(-5)M), a cyclooxygenase (COX) inhibitor (indomethacin; 10(-5)M) or the two in combination. Sensitivity to ACh was comparable between diabetic and control mice. However, the contribution of endothelium-dependent vasodilators was significantly altered. L-NNA significantly inhibited the relaxation of arteries from diabetic compared to control mice (65+/-11% vs 18+/-6%; p<.05). L-NNA and indomethacin significantly inhibited the relaxation of arteries from diabetic mice compared to control (87+/-5% vs 33+/-14%; p<0.05). These data indicate that endothelium-dependent relaxation of the uterine artery of control, pregnant mice was largely mediated by the non-NO/non-COX component. Surprisingly, arteries from diabetic mice were primarily dependent on NO, which may affect compensatory capacity as the disease progresses.

Early endothelial dysfunction following renal mass reduction in rats

BACKGROUND

Endothelial dysfunction has been previously described in severely hypertensive rats with renal mass reduction (RMR) receiving large dietary Na loads. Because hypertension and Na loading reduce endothelium-dependent vasodilation, the effect of renal failure per se is unclear.

METHODS

Responses to acetylcholine in noradrenaline-contracted isolated perfused mesenteric arteries were studied. Vessels were obtained from RMR rats kept on a normal diet, 3 and 10 days after surgery, and the results were compared with those from sham-operated rats (SN). The role of three putative mediators of endothelium-dependent vasodilation was assessed using: L-NAME (10(-4) mol L(-1)); indomethacin (INDO, 10(-5) mol L(-1)); and a mixture of charybdotoxin and apamin (C/A, both 10(-7) mol L(-1)), inhibitors of Ca-activated K-channels to mediate the effects of endothelium-derived hyperpolarizing factor (EDHF).

RESULTS

Response to acetylcholine but not that to nitroprusside (endothelium-independent) was decreased in RMR. L-NAME reduced further acetylcholine relaxations in SN but not in RMR. By contrary, INDO decreased acetylcholine vasodilation in RMR but had no effect in SN. C/A had similar effects in the SN and RMR rats. The levels of 6-keto prostaglandin F1alpha were elevated in the urine of the RMR rats and were perfusate from the RMR vessels.

CONCLUSION

Endothelial dysfunction occurs early after RMR, even when systolic blood pressure is only minimally elevated and Na intake is normal. This alteration may be because of decreased availability of nitric oxide, partially compensated by increased prostacyclin production.

Role of calcium-activated potassium channels in impaired acetylcholine vasodilatory responses in diabetic rats

Muscarinic agonists produce endothelium-dependent vasodilatation in the presence of nitric oxide synthase (NOS) inhibition. The importance of this mechanism was assessed in the methoxamine-preconstricted perfused mesenteric vascular bed (MVB) of streptozotocin diabetic Sprague-Dawley rats. At 9 weeks of age, male rats were treated with streptozotocin (55 mg/kg in citrate buffer) or with citrate buffer alone. The superior mesenteric artery was cannulated and the MVB was detached from its intestinal borders. Concentration-response curves to acetylcholine were determined in the presence and in the absence of indomethacin, tetrabutylammonium (a calcium-activated potassium channel blocker), high extracellular potassium, or NOS inhibition with Nomega-nitro-l-arginine and l-NG-nitro-l-arginine. There was a rightward shift in the concentration-response curve with an increase in median inhibitory concentration (p < 0.05) and a reduction in acetylcholine IMAX (p < 0.05) values in 14-week streptozotocin rats. The ability of NOS inhibition to attenuate vasodilatation was reduced in the 14-week streptozotocin group relative to the 2-week streptozotocin treatment group (p < 0.05). However, the ability of tetrabutylammonium to block acetylcholine-mediated vasodilatation remained consistent in streptozotocin rats at both stages. The results demonstrate that an alternate pathway involving calcium-activated potassium channels may compensate for diminished nitric oxide bioactivity. This effect is contingent on the duration of diabetes. This study provides insight into the development and progression of altered diabetic vascular responses.

Endothelial dysfunction and hypertension in 5/6 nephrectomized rats are mediated by vascular superoxide

BACKGROUND

Nitric oxide inactivation by superoxide impairs endothelium-dependent vasodilation and plays a role in various forms of hypertension. Almost no data exist regarding hypertension secondary to chronic renal failure. Previous studies have shown that endothelium-related relaxations, secondary to decreased nitric oxide bioactivity, are impaired in resistance vessels from rats 3 to 10 days after renal mass reduction (RMR).

METHODS

The membrane-permeable superoxide dismutase (SOD)-mimetic (tempol) was administered IP (1.5 mmol/kg/day for 10 days) to RMR rats and sham-operated controls (SN). Systolic blood pressure (SBP) was measured by tail cuff manometry at days 0, 3, 6 and 10. The increase of flow induced by acetylcholine (10-6 mol/L) was measured in isolated perfused mesenteric arteries from RMR and SN rats pre-contracted with noradrenaline (1 to 5 micromol/L), with or without exogenous SOD. Plasma levels of advanced oxidative protein products (AOPPs; chloramine-T equivalents) were measured in SN and RMR rats.

RESULTS

Tempol prevented the increase of SBP: 118 +/- 2.2 mm Hg at baseline and 122 +/- 1.6 mm Hg at 10 days in tempol-treated vs 118.14 +/- 1.65 mm Hg at baseline and 145 +/- 7.69 mm Hg at 10 days in untreated RMR rats (P < 0.01). Responsiveness to acetylcholine was reduced in RMR rats (peak flow increase: 139 +/- 7.8% vs. 176 +/- 11% in SN, P=0.028 at 3 days and 140 +/- 6.4% vs. 187 +/- 16.9% in SN at 10 days, P=0.007). In arteries pre-incubated with SOD (200 U/mL) the peak flows were 175 +/- 9.4% at 3 days and 157 +/- 5.8% at 10 days (P=0.007 and P=0.051, respectively, vs. control RMR vessels). AOPP values were significantly increased in plasma from RMR rats 3 days after 5/6 nephrectomy (747 +/- 107 vs. 481 +/- 77 micromol/L, P < 0.05) but returned to normal by day 10. AOPP levels were not significantly reduced by tempol.

CONCLUSIONS

Increased vascular superoxide production plays a central role in the development of vascular endothelial dysfunction and hypertension early after 5/6 nephrectomy.

Nitric oxide inhibition simulates the enhancement of alpha 1 agonist-induced vasoconstriction in diabetes

We have previously reported that endothelium-dependent, nitric oxide (NO)-mediated vasorelaxation is impaired in diabetic mesenteric arteries. We hypothesized that vasoconstrictor responses should therefore be enhanced. The purpose of this study was to determine whether diabetic mesenteric arteries exhibit increased vasoconstrictor responses, and to investigate if these changes are receptor and/or NO mediated. Thirty age-matched male Sprague-Dawley rats were divided into control (C) and diabetic (D, streptozotocin: 60 mg/kg) groups and studied after 4 weeks. Terminal branches of ileal mesenteric arteries (300 +/- 9 microns) were isolated, pressurized, and superfused with modified Krebs solution. Changes in vessel internal diameter were measured and dose-response curves (DRC) for each vasoactive agent were determined. Each vessel was initially constricted with 40 mM of KC1 to determine maximal vasoconstriction. Phenylephrine (Phe, 10(-8)-10(-4) M) and UK14304 (10(-9)-10(-5) M) were used to determine alpha 1- and alpha 2-receptor responses, respectively. Similar studies were performed in the presence of N omega-nitro-L-arginine methyl ester (L-NAME, 10(-4) M), a competitive inhibitor of NO synthase. Maximal response (Max), area under the curve (AUC), and vessel sensitivity (ED50) for each DRC were calculated. Comparisons among groups were made using analysis of variance and Student's t test with Bonferroni correction. There were no differences in vasoconstrictor responses induced by KCl (C: 82 +/- 2% vs D: 80 +/- 1%). alpha 1-vasoconstrictor responses to Phe were enhanced in diabetes with significantly higher Max (96 +/- 2% vs 83 +/- 3%), and AUC (1.92 +/- 0.09 vs 1.56 +/- 0.08), but no difference in ED50. The addition of L-NAME enhanced only Phe-induced vasoconstrictor response significantly in control rats. Thus, differences in Phe-induced vasoconstrictor responses between C and D were abolished in the presence of L-NAME. alpha 2-vasodilator responses induced by UK14304 were similar between C and D and unaffected by L-NAME. alpha 1-, but not alpha 2-, vasoconstrictor responses are enhanced in streptozotocin-induced diabetic rats. These enhanced responses can be duplicated by treatment of control vessels with L-NAME.