Gender-Specific Differences in the In Situ Cardiac Function of Endotoxemic Rats Detected by Pressure-Volume Catheter

Sex-specific differences in cardiac function, inflammation and injury during early polymicrobial sepsis

BACKGROUND

Sex differences in sepsis are underexplored and incompletely understood. Cardiac function in early sepsis is pivotal in determining survival; hyperdynamic left ventricular ejection fraction is associated with higher mortality. Female sex may be cardioprotective, but variable experimental findings have not controlled for hypovolaemia. Sex-specific local cardiac versus peripheral inflammation in causing cardiovascular dysfunction also remain unclear. We therefore examined whether there are sex-specific differences in cardiac function in early sepsis, controlling for volaemic status and sex-specific differences in the peripheral inflammatory response initiated by tumour necrosis factor (TNFα).

METHODS

We used an experimental polymicrobial sepsis (faecal slurry) model titrated to minimise hypovolaemia as a confounding factor. We quantified cardiac function (transthoracic cardiac echocardiography) 1 week before, and 18 h after, sepsis. Cardiac injury (troponin I), inflammation and immune cell infiltration (flow cytometry) were quantified in naïve and septic female and male mice 18 h after sepsis. To evaluate the sex-specific influence of TNFα derived from peripheral leukocytes, we repeated the experiments in iRHOM2^-/- mice that are unable to shed TNFα exclusively from circulating leucocytes.

RESULTS

Serum troponin I increased to 1.39 ± 0.38 ng mL^-1 (from undetectable levels in controls) 18 h after onset of normovolaemic sepsis to a similar extent in both sexes. Stroke volume in male mice increased by 8 µL [(3-13); p = 0.004], compared to individualised pre-sepsis values. By contrast, stroke volume remained at baseline levels in females [mean difference: 4 µL (- 1 to 9)]. Messenger RNA levels of markers for cardiac injury/inflammation after sepsis (real-time polymerase-chain reaction) were elevated in male wild-type mice compared to female wild types (n = 10/sex), with higher cardiac mRNA levels of atrial natriuretic peptide, inflammation (TNFα) and oxidative stress (superoxide dismutase-1), although serum troponin I values were similarly elevated. Flow cytometry analysis of cardiac tissue showed doubling of CD4 + leukocyte infiltration in male mice. Sex-specific cardiac physiologic differences were similar in iRHOM2^-/- mice that are unable to shed TNFα exclusively from leucocytes.

CONCLUSIONS

In early normovolaemic polymicrobial sepsis, a relative hyperdynamic response develops in male mice. Myocardial stress/injury after early sepsis is limited in females, with less cardiac infiltration of CD4 + leukocytes but independent of shedding of TNFα from peripheral circulating leukocytes.

Rho-Proteins and Downstream Pathways as Potential Targets in Sepsis and Septic Shock: What Have We Learned from Basic Research

Sepsis and septic shock are associated with acute and sustained impairment in the function of the cardiovascular system, kidneys, lungs, liver, and brain, among others. Despite the significant advances in prevention and treatment, sepsis and septic shock sepsis remain global health problems with elevated mortality rates. Rho proteins can interact with a considerable number of targets, directly affecting cellular contractility, actin filament assembly and growing, cell motility and migration, cytoskeleton rearrangement, and actin polymerization, physiological functions that are intensively impaired during inflammatory conditions, such as the one that occurs in sepsis. In the last few decades, Rho proteins and their downstream pathways have been investigated in sepsis-associated experimental models. The most frequently used experimental design included the exposure to bacterial lipopolysaccharide (LPS), in both in vitro and in vivo approaches, but experiments using the cecal ligation and puncture (CLP) model of sepsis have also been performed. The findings described in this review indicate that Rho proteins, mainly RhoA and Rac1, are associated with the development of crucial sepsis-associated dysfunction in different systems and cells, including the endothelium, vessels, and heart. Notably, the data found in the literature suggest that either the inhibition or activation of Rho proteins and associated pathways might be desirable in sepsis and septic shock, accordingly with the cellular system evaluated. This review included the main findings, relevance, and limitations of the current knowledge connecting Rho proteins and sepsis-associated experimental models.

Cardioprotective Effects of Dietary Phytochemicals on Oxidative Stress in Heart Failure by a Sex-Gender-Oriented Point of View

Dietary phytochemicals are considered an innovative strategy that helps to reduce cardiovascular risk factors. Some phytochemicals have been shown to play a beneficial role in lipid metabolism, to improve endothelial function and to modify oxidative stress pathways in experimental and clinical models of cardiovascular impairment. Importantly, investigation on phytochemical effect on cardiac remodeling appears to be promising. Nowadays, drug therapy and implantation of devices have demonstrated to ameliorate survival. Of interest, sex-gender seems to influence the response to HF canonical therapies. In fact, starting by the evidence of the feminization of world population and the scarce efficacy and safety of the traditional drugs in women, the search of alternative therapeutic tools has become mandatory. The aim of this review is to summarize the possible role of dietary phytochemicals in HF therapy and the evidence of a different sex-gender-oriented response.

Time and sex dependency of hemodynamic, renal, and survivability effects of endotoxemia in rats

Widely different exposure times to endotoxic insults have been employed in reported studies. The current experimental study systematically evaluated the time-course and sex influences of endotoxic insult on survivability and cardiovascular and renal functions. Rats received i.p. lipopolysaccharide (LPS, 5 mg/kg) once or twice (over 2 successive days). Systolic blood pressure (SBP), biomarkers of renal function and inflammation, and vasodilator responsiveness of isolated perfused kidneys to acetylcholine (ACh) or N-ethylcarboxamidoadenosine (NECA) were evaluated 6 hr after first LPS injection or 1, 2, or 6 days later. A single 6-hr LPS challenge caused (i) sex-unrelated elevations in serum urea and creatinine and reductions in NECA, but not ACh, vasodilations, (ii) more increases in renal NF-κB/iNOS expressions in male than in female rats, and (iii) hypotension and tachycardia only in male rats. These parameters, except for hemodynamic changes, were restored to near-control levels 1 day after single LPS dosing. The 2-days dosing with LPS had no effects on renal function biomarkers, but caused hypotension, tachycardia, and increases in renal NF-κB/iNOS expression and NECA and ACh vasodilations in both rat sexes. None of these parameters were different from control values when measured 6 days after the endotoxic insult. Alternatively, the rat mortality was observed during first 2 days of the study and was notably higher in male than in female rats. Our data suggest that the frequency and time elapsed after LPS exposure as well as rat sex are important determinants of the magnitude and direction of detrimental effects of endotoxemia.

Alpha-1 Adrenergic Receptor Agonist Phenylephrine Inhibits Sepsis-Induced Cardiomyocyte Apoptosis and Cardiac Dysfunction via Activating ERK1/2 Signal Pathway

It was demonstrated that α1 adrenergic receptor (α1-AR) activation by phenylephrine (PE) attenuated cardiac dysfunction in lipopolysaccharide (LPS)-challenged mice. However, it is unclear whether PE suppresses sepsis-induced cardiomyocyte apoptosis. Here, we investigated the effects of PE on cardiomyocyte apoptosis in LPS-treated adult rat ventricular myocytes (ARVMs) and septic rats induced by cecal ligation and puncture. Cardiomyocyte apoptosis and caspase activity were detected by TUNEL and spectrophotometrical assay, respectively. Bax, Bcl-2 and cytochrome c (Cyt c) levels as well as IκBα, ERK1/2, p38 MAPK, JNK and cardiac troponin I (cTnI) phosphorylation were analyzed by Western blotting, and TNF-α concentration was analyzed by ELISA. PE inhibited LPS-induced caspase-3 activation in ARVMs, which was reversed by prazosin (a membrane permeable α1-AR antagonist), but not by CGP12177A (a membrane impermeable α1-AR antagonist). PE upregulated phosphorylated ERK1/2 and Bcl-2 contents, decreased TNF-α and Bax levels, Cyt c release, caspase-8/-9 activities as well as IκBα, p38MAPK and JNK phosphorylation in LPS-treated ARVMs, all of which were abolished by prazosin. Treatment with U0126 (a specific ERK1/2 inhibitor) reversed the effects of PE on IκBα, p38MAPK and JNK phosphorylation as well as caspase-3/-8/-9 activation in LPS-treated ARVMs. In septic rats, PE not only inhibited myocardial apoptosis as well as IκBα, p38MAPK, and JNK phosphorylation, but also upregulated myocardial phosphorylated ERK1/2. Furthermore, PE inhibited myocardial cTnI phosphorylation and improved cardiac function in septic rats. Taken together, our data suggest that α1-AR activation by PE inhibits sepsis-induced cardiomyocyte apoptosis and cardiac dysfunction via activating ERK1/2 signal pathway.

Bradykinin increases BP in endotoxemic rat: functional and biochemical evidence of angiotensin II AT1 /bradykinin B2 receptor heterodimerization

BACKGROUND AND PURPOSE

Bradykinin may induce vasoconstriction in selected vessels or under specific experimental conditions. We hypothesized that inflammatory stimuli, such as endotoxin challenge, may induce the dimerization of AT₁ /B₂ receptors, altering the vascular effects of bradykinin.

EXPERIMENTAL APPROACH

Wistar rats received LPS (1 mg·kg^-1 , i.p.) and were anaesthetized for assessment of BP. Mesenteric resistance arteries were used in organ baths and subjected to co-immunoprecipitation and Western blot analyses.

KEY RESULTS

At 24 and 48 hr after LPS, bradykinin-induced hypotension was followed by a sustained increase in BP, which was not found in non-endotoxemic animals. The B₂ receptor antagonist Hoe-140 fully blocked the responses to bradykinin. The pressor effect of bradykinin was not prevented by prazosin, an α₁ -adrenoceptor antagonist, but it was inhibited by the AT₁ receptor antagonist losartan or the Rho-kinase inhibitor Y-27632. Endotoxemic rats also displayed enhanced pressor responses to angiotensin II, which were blocked by Hoe-140. Co-immunoprecipitation isolated using anti-B₂ or anti-AT₁ receptor antibodies showed that resistance arteries presented augmented levels of the AT₁ /B₂ receptor complexes at 24 hr after LPS injection. The presence of AT₁ /B₂ receptor heterodimers did correlate with the development of losartan-sensitive contractile responses to bradykinin and potentiation of angiotensin II-induced contraction, which was prevented by Hoe-140.

CONCLUSIONS AND IMPLICATIONS

Endotoxin challenge is a stimulus for AT₁ /B₂ receptor heterodimerization in native vessels and shifts the B₂ receptor-dependent vascular effect of bradykinin to a more complex pathway, which also depends on AT₁ receptors and their intracellular signalling pathways.

Gonadal hormone receptors underlie the resistance of female rats to inflammatory and cardiovascular complications of endotoxemia

The male gender is more vulnerable to immunological complications of sepsis. Here, we tested the hypotheses that female rats are protected against endotoxemia-evoked hypotension and cardiac autonomic dysfunction, and that gonadal hormone receptors account for such protection. Changes in blood pressure, heart rate, and cardiac sympathovagal balance caused by i.v. lipopolysaccharide (LPS) were determined. In male rats, LPS elevated serum TNFα together with falls in blood pressure and rises in heart rate. The spectral index of cardiac sympathovagal balance (low-frequency/high-frequency ratio, LF/HF) was reduced by LPS, suggesting an enhanced parasympathetic dominance. Remarkably, none of these LPS effects was evident in female rats. We also report that pretreatment of female rats with fulvestrant (nonselective estrogen receptor blocker), PHTPP (estrogen receptor β blocker), or mifepristone (progesterone receptor blocker) uncovered clear inflammatory (increased serum TNFα), hypotensive and tachycardic responses to LPS. However, these female rats, contrary to their male counterparts, exhibited increases in LF/HF ratio. On the other hand, LPS failed to modify inflammatory or cardiovascular states in rats pretreated with MPP (estrogen receptor α blocker). In females treated with formestane (aromatase inhibitor), LPS increased LF/HF ratio but had no effect on blood pressure. In male rats, the hypotensive and cardiac autonomic effects of LPS were (i) eliminated after treatment with estrogen, and (ii) intensified and inhibited, respectively, in flutamide (androgen receptor blocker)-pretreated rats. These findings highlight important roles for female gonadal hormones and functional estrogen receptor β and progesterone receptors in offsetting inflammatory and cardiovascular derangements caused by endotoxemia in female rats.

Gender difference in oxidative stress: a new look at the mechanisms for cardiovascular diseases

Gender differences are present in many diseases and are especially prevalent in cardiovascular disease. Males tend to suffer from myocardial infarctions earlier than females, and a woman's risk of cardiovascular disease increases after menopause, suggesting a cardio-protective role of estrogen. However, hormone replacement therapy did not decrease the risk of cardiovascular disease in post-menopausal women; thus, other mechanisms may be involved besides estrogen. Oxidative stress plays an important role in the development of cardiovascular diseases such as coronary artery disease. Gender is also associated with differences in oxidative stress. Under physiological conditions, females appear to be less susceptible to oxidative stress. This may be due to the antioxidant properties of estrogen, gender differences in NADPH-oxidase activity or other mechanism(s) yet to be defined. This review strives to discuss gender differences in general terms followed by a more detailed examination of gender differences with oxidative stress and various associated diseases and the possible mechanisms underlying these differences.

Is female gender as harmful as bacteria? analysis of hospital admissions for urinary tract infections in elderly patients

BACKGROUND

Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and in-hospital mortality (IHM) in a cohort of hospitalized elderly subjects.

METHODS

All patients admitted between 2000 and 2013 to the general hospital of Ferrara, in northeast Italy, with ICD-9-CM code of UTIs were included. IHM was the main outcome, and age, sex, type of microorganism, sepsis, and Charlson comorbidity index (CCI) based on ICD-9-CM, were also analyzed.

RESULTS

The total sample included 2,266 patients (1,670 women, 73.7%) with UTIs and identification of a cultural organism. Mean age was 81.7±7.5 years (range, 65-103). One hundred and sixteen (5.1%, of whom 34.5% were male and 65.5% were female) cases developed sepsis, and 84 (3.7%, of whom 45.2% were male, 54.8% were female) had a fatal outcome. Nonsurvivors had lower prevalence of IVUs due to Escherichia coli (53.6 vs. 71.7%, p<0.001) and higher prevalence of UTIs due to Pseudomonas aeruginosa (19 vs 7.1%, p<0.001). Moreover, non-survivors developed more frequently sepsis (31% vs. 4.1%, p<0.001), and had higher CCI (2.81±2.43 vs. 2.21±2.04, p=0.011). IHM was independently associated, in decreasing order of odds ratios (ORs), with sepsis (OR 10.3; 95% confidence interval [95% CI] 6.113-17.460, p<0.001), P. aeruginosa infection (OR 2.541; 95% CI 1.422-4.543, p=0.002), female gender (OR 2.324; 95% CI 1.480-3.650, p<0.001), CCI (OR 1.103; 95% CI 1.005-1.210, p=0.038), age (OR 1.034; 95% CI 1.002-1.066, p=0.036), and E. coli infection (OR 0.5; 95% CI 0.320-0.780, p=0.002).

CONCLUSIONS

In a large sample of elderly patients hospitalized for UTIs in a single center in northeastern Italy, apart the development of sepsis, IHM was much more dependent on pathogen and female gender than comorbidity index and age.