Short-term modulation of distal tubule fluid nitric oxide in vivo by loop NaCl reabsorption

Thick Ascending Limb Sodium Transport in the Pathogenesis of Hypertension

The thick ascending limb plays a key role in maintaining water and electrolyte balance. The importance of this segment in regulating blood pressure is evidenced by the effect of loop diuretics or local genetic defects on this parameter. Hormones and factors produced by thick ascending limbs have both autocrine and paracrine effects, which can extend prohypertensive signaling to other structures of the nephron. In this review, we discuss the role of the thick ascending limb in the development of hypertension, not as a sole participant, but one that works within the rich biological context of the renal medulla. We first provide an overview of the basic physiology of the segment and the anatomical considerations necessary to understand its relationship with other renal structures. We explore the physiopathological changes in thick ascending limbs occurring in both genetic and induced animal models of hypertension. We then discuss the racial differences and genetic defects that affect blood pressure in humans through changes in thick ascending limb transport rates. Throughout the text, we scrutinize methodologies and discuss the limitations of research techniques that, when overlooked, can lead investigators to make erroneous conclusions. Thus, in addition to advancing an understanding of the basic mechanisms of physiology, the ultimate goal of this work is to understand our research tools, to make better use of them, and to contextualize research data. Future advances in renal hypertension research will require not only collection of new experimental data, but also integration of our current knowledge.

Low [NaCl]-induced neuronal nitric oxide synthase (nNOS) expression and NO generation are regulated by intracellular pH in a mouse macula densa cell line (NE-MD)

Changes in the luminal NaCl concentration ([NaCl]) at the macula densa (MD) modulate the tubuloglomerular feedback (TGF) responses via an affect on the release of nitric oxide (NO). This study was performed in a newly established mouse macula densa cell line (NE-MD) to investigate the effects of lowering [NaCl] on the neuronal NO synthase (nNOS) protein expression and L-arginine (Arg)-induced NO release. Expression of nNOS protein and release of NO were evaluated by Western blot analysis and an NO-sensitive electrode, respectively. Intracellular pH (pH(i)) was monitored by the BCECF assay. Although there was weak staining of the nNOS protein expression, L-Arg-induced NO generation was negligible in normal (140 mM NaCl) solution. Both were significantly (P < 0.05) increased either in the presence of furosemide (12 microM), an inhibitor of the Na(+)-K(+)-2Cl(-) cotransporter, or in a low (23 mM) Cl(-) solution. Furosemide- and low Cl(-)-induced NO generation was completely inhibited by 50 microM 7-nitroindasole (7-NI), a nNOS inhibitor. Moreover, these increases were significantly (P < 0.05) inhibited by the addition of 100 microM amiloride, an inhibitor of the Na(+)/H(+) exchanger, or by its analogue 5-(N)-ethyl-N-isopropyl amiloride (EIPA), and also at a lower pH of 7.1. Furthermore, nNOS expression and NO release were not stimulated in as low as 19 mM Na(+) solution. In conclusion, low [Cl(-)], but not low [Na(+)] in the lumen at the MD, increased nNOS protein expression and NO generation. Changes in the luminal [NaCl] may modulate the TGF system via an effect on the NO generation from the MD.

Real-time dynamics of nitric oxide shifts within the esophageal wall

BACKGROUND

Currently, indirect evidence suggests that the neurotransmitter nitric oxide (NO) plays a crucial role in the genesis of aboral propagation of esophageal peristalses during swallowing. However, direct evidence in this regard currently is lacking. This study aimed to assess the feasibility of using NO-selective microprobes to detect real-time NO changes within the esophageal wall of North American opossums (Didelphis virginiana) during normal progressive esophageal peristalsis and induced esophageal dysmotility.

METHODS

Six adult opossums of both sexes (mean weight, 2.28 +/- 0.41 kg) were included in the study. All had normal esophageal motility, as documented by water-perfused esophageal manometry. A calibrated carbon fiber NO-selective microelectrode (ISNOP30, ISNOP100) was placed within the smooth muscle portion of the esophageal wall, and changes in NO levels were measured as redox current in pico-amperes (pA) with the Apollo-4000 NO meter. The dynamics of NO in response to reflexive deglutition were assessed during both normal propagative peristalsis and abnormal esophageal contractions induced by intravenous (i.v.) administration of the neural NO synthase inhibitor L-nitro L-arginine methyl ester (L-NAME) and banding of the gastroesophageal junction (GEJ) for 4-weeks.

RESULTS

During normal propagative esophageal peristalsis, a mean change of 2,158.85 +/- 715.93 pA was measured by the NO meter. Intravenous administration of L-NAME and chronic banding of the GEJ induced achalasia-like esophageal contractions. A significantly smaller change in levels of NO was detected within the esophageal wall during dysfunctional motility (331.94 +/- 188.17 pA; p < 0.001) than during normal propagative peristalsis (579 +/- 385 pA; p < 0.001).

CONCLUSION

The results of this study indicate that carbon fiber NO-selective microprobes can successfully measure changes in the concentration of NO, an important inhibitory neurotransmitter, within the esophageal wall and that these preliminary data support the involvement of this crucial neurotransmitter in programming normal propagation of peristaltic waves within the esophagus.

Protective effects of antioxidant-fortified diet on renal function and metabolic profile in obese Zucker rat

Oxidative stress contributes to the pathophysiology of type 2 diabetes mellitus and its complications, including nephropathy. The current study was designed to test the hypothesis that a diet fortified with antioxidants would be beneficial to delay or prevent the progression of this disease. Male and female Zucker fa/fa rats were fed a control or an antioxidant (AO)-fortified diet starting at 4 weeks of age. Metabolic parameters, renal function, and renal histopathology were analyzed at 6, 13, and 20 weeks of age. Females on the AO diet had significantly lower blood glucose at 6 and 13 weeks, less severe renal pathology at 20 weeks, and higher glomerular filtration rates (GFR) at 20 weeks than age-matched females on the regular diet (P < 0.05). Metabolic parameters including blood glucose, insulin resistance, and serum cholesterol, and mean arterial pressure (MAP), worsened with age in both males and females, as expected. GFR decreased and renal pathology also became more severe with age. Finally, females on the AO diet had higher GFRs and lower MAP at 20 weeks than males on the same diet. This may denote a protective effect of the AO diet in females, but not in males. These findings may have implications for the role of antioxidants as therapy in humans with T2DM.

Tubuloglomerular feedback: mechanistic insights from gene-manipulated mice

Tubuloglomerular feedback (TGF) describes a causal and direct relationship between tubular NaCl concentration at the end of the ascending limb of the loop of Henle and afferent arteriolar tone. The use of genetically altered mice has led to an expansion of our understanding of the mechanisms underlying the functional coupling of epithelial, mesangial, and vascular cells in TGF. Studies in mice with deletions of the A or B isoform of NKCC2 (Na,K,2Cl cotransporter) and of ROMK indicate that NaCl uptake is required for response initiation. A role for transcellular salt transport is suggested by the inhibitory effect of ouabain in mutant mice with an ouabain-sensitive alpha1 Na,K-ATPase. No effect on TGF was observed in NHE2- and H/K-ATPase-deficient mice. TGF responses are abolished in A1 adenosine receptor-deficient mice, and studies in mice with null mutations in NTPDase1 or ecto-5'-nucleotidase indicate that adenosine involved in TGF is mainly derived from dephosphorylation of released ATP. Angiotensin II is a required cofactor for the elicitation of TGF responses, as AT1 receptor or angiotensin-converting enzyme deficiencies reduce TGF responses, mostly by reducing adenosine effectiveness. Overall, the evidence from these studies in genetically altered mice indicates that transcellular NaCl transport induces the generation of adenosine that, in conjunction with angiotensin II, elicits afferent arteriolar constriction.

Nitric oxide selective electrodes

Since nitric oxide (NO) was identified as the endothelial-derived relaxing factor in the late 1980s, many approaches have attempted to provide an adequate means for measuring physiological levels of NO. Although several techniques have been successful in achieving this aim, the electrochemical method has proved the only technique that can reliably measure physiological levels of NO in vitro, in vivo, and in real time. We describe here the development of electrochemical sensors for NO, including the fabrication of sensors, the detection principle, calibration, detection limits, selectivity, and response time. Furthermore, we look at the many experimental applications where NO selective electrodes have been successfully used.

Nitric oxide production by mouse renal tubules can be increased by a sodium-dependent mechanism

Renal tubules process large amounts of NaCl that other investigators indicate increases tubular generation of nitric oxide. We questioned whether medullary or superficial cortical tubules would have the greater increase in nitric oxide concentration, [NO], when stressed by sodium and if the sodium/calcium exchanger was involved. Sodium stress in proximal tubules is due to the large amount of sodium absorbed and medullary tubules exist in a hypertonic sodium environment. To sodium stress the tissue, mouse kidney slices were exposed to monensin to allow passive entry of sodium ions from isotonic media and in separate studies, 400 and 600 mOsm NaCl was used. [NO] was measured with microelectrodes. Monensin (10 microM) caused a sustained increase in medullary and cortical [NO] to approximately 180% of control and 400 mOsm NaCl caused a similar initial increase in [NO] that then subsided. 600 mOsm NaCl caused a more sustained increase in [NO] of >250% of control. L-NAME strongly attenuated the increased [NO] during sodium stress. The increase in [NO] during NaCl elevation was due to sodium ions because mannitol hyperosmolarity caused approximately 20% of the increase in [NO]. Entry of sodium during NaCl hyperosmolarity was through bumetanide sensitive channels because the drug suppressed increased [NO]. Blockade of the sodium/calcium ion exchanger strongly suppressed the increased [NO] during monensin, to increase sodium entry into cells, and the elevated NaCl concentration. The data support a sodium-NO linkage that increased NO signaling in proportion to sodium stress by cortical tubules and was highly dependent upon sodium-calcium exchange.

Hyperfiltration, nitric oxide, and diabetic nephropathy

Early diabetes is often accompanied by an increased glomerular filtration rate (GFR). This hyperfiltration, which is significantly dependent upon increased nitric oxide activity, is believed to contribute to progression of diabetic nephropathy. In this article, a technique for the measurement of tubular fluid nitric oxide in vivo, in real time, is reviewed, and findings in three commonly used rodent models of diabetes are described. The mechanisms of altered tubuloglomerular feedback (TGF) in diabetes are also reviewed, with emphasis on hyperfiltration and the role of nitric oxide. New findings on the modulation of hyperfiltration in the classic type 2 diabetes db/db mouse are presented, showing suppression of the TGF mechanism and modulation of single-nephron GFR by a specific nitric oxide synthase inhibitor.

Real-time measurement of kidney tubule fluid nitric oxide concentrations in early diabetes: Disparate changes in different rodent models

There are several reports indicating that nitric oxide (NO) plays a role in the kidney hyperfiltration seen in the early stages of diabetes mellitus (DM). Whole kidney GFR and single nephron GFR (SNGFR) have been reported to decrease after nitric oxide synthase (NOS) inhibition. To date, no direct, in vivo, quantitative NO measurements have been made within the kidney in any models of early diabetes. To assess the possible association of changes in tubular fluid nitric oxide concentrations (TF [NO]) with early diabetes, a specially modified NO electrode with a tip diameter of about 7 microm was used to measure NO in single tubules in seven rodent groups. In the Sprague-Dawley (SD) rat model, TF [NO] increased by 50% after streptozotocin (STZ) induced DM1. In the B6129G2/J mouse, control TF [NO] was more than twice the rat control value and fell by 50% after STZ treatment. In three other groups of mice-db/db (B6.Cg-m+/+Lepr(db)/J) Type II diabetic (DM2) mouse, db/m (its heterozygote), and the corresponding wild type (WT)-TF [NO] was also much higher than in the rat, and unlike the B6129G2/J STZ diabetic mouse, did not change after the onset of diabetes. Blood glucose concentrations were similar in the three diabetic groups. Accordingly, in different rodent models of diabetes, in vivo TF [NO], measured in real time, varies significantly in control animals and directionally in different models of DM1 and DM2.

Renal autoregulation: new perspectives regarding the protective and regulatory roles of the underlying mechanisms

When the kidney is subjected to acute increases in blood pressure (BP), renal blood flow (RBF) and glomerular filtration rate (GFR) are observed to remain relatively constant. Two mechanisms, tubuloglomerular feedback (TGF) and the myogenic response, are thought to act in concert to achieve a precise moment-by-moment regulation of GFR and distal salt delivery. The current view is that this mechanism insulates renal excretory function from fluctuations in BP. Indeed, the concept that renal autoregulation is necessary for normal renal function and volume homeostasis has long been a cornerstone of renal physiology. This article presents a very different view, at least regarding the myogenic component of this response. We suggest that its primary purpose is to protect the kidney against the damaging effects of hypertension. The arguments advanced take into consideration the unique properties of the afferent arteriolar myogenic response that allow it to protect against the oscillating systolic pressure and the accruing evidence that when this response is impaired, the primary consequence is not a disturbed volume homeostasis but rather an increased susceptibility to hypertensive injury. It is suggested that redundant and compensatory mechanisms achieve volume regulation, despite considerable fluctuations in distal delivery, and the assumed moment-by-moment regulation of renal hemodynamics is questioned. Evidence is presented suggesting that additional mechanisms exist to maintain ambient levels of RBF and GFR within normal range, despite chronic alterations in BP and severely impaired acute responses to pressure. Finally, the implications of this new perspective on the divergent roles of the myogenic response to pressure vs. the TGF response to changes in distal delivery are considered, and it is proposed that in addition to TGF-induced vasoconstriction, vasodepressor responses to reduced distal delivery may play a critical role in modulating afferent arteriolar reactivity to integrate the regulatory and protective functions of the renal microvasculature.

Tubuloglomerular feedback-dependent modulation of renal myogenic autoregulation by nitric oxide

Nonselective inhibition of nitric oxide (NO) synthase (NOS) augments myogenic autoregulation, an action that implies enhancement of pressure-induced constriction and dilatation. This pattern is not explained solely by interaction with a vasoconstrictor pathway. To test involvement of the Rho-Rho kinase pathway in modulation of autoregulation by NO, the selective Rho kinase inhibitor Y-27632 and/or the NOS inhibitor N(omega)-nitro-l-arginine methyl ester (l-NAME) were infused into the left renal artery of anesthetized rats. Y-27632 and l-NAME were also infused into isolated, perfused hydronephrotic kidneys to assess myogenic autoregulation over a wide range of perfusion pressure. In vivo, l-NAME reduced renal vascular conductance and augmented myogenic autoregulation, as shown by increased slope of gain reduction and associated phase peak in the pressure-flow transfer function. Y-27632 (10 mumol/l) strongly dilated the renal vasculature and profoundly inhibited autoregulation in the absence or presence of l-NAME in vivo and in vitro. Afferent arteriolar constriction induced by 30 mmol/l KCl was reversed (-92 +/- 3%) by Y-27632. Phenylephrine caused strong renal vasoconstriction but did not affect autoregulation. Inhibition of neuronal NOS by N(5)-(1-imino-3-butenyl)-l-ornithine (l-VNIO) did not cause significant vasoconstriction but did augment myogenic autoregulation. Thus vasoconstriction is neither necessary (l-VNIO) nor sufficient (phenylephrine) to explain the augmented myogenic autoregulation induced by l-NAME. The effect of l-VNIO implicates tubuloglomerular feedback (TGF) and neuronal NOS at the macula densa in regulation of the myogenic mechanism. This conclusion was confirmed by the demonstration that systemic furosemide removed the TGF signature from the pressure-flow transfer function and significantly inhibited myogenic autoregulation. In the presence of furosemide, augmentation of myogenic autoregulation by l-NAME was significantly reduced. These results provide a potential mechanism to explain interaction between myogenic and TGF-mediated autoregulation.

Increased intracellular pH at the macula densa activates nNOS during tubuloglomerular feedback

BACKGROUND

The macula densa senses increasing NaCl concentrations in tubular fluid and increases afferent arteriole tone by a process known as tubuloglomerular feedback (TGF). Nitric oxide (NO) production by macula densa neuronal nitric oxide synthase (nNOS) is enhanced by increasing NaCl in the macula densa lumen, and the NO thus formed inhibits TGF. Blocking apical Na(+)/H(+) exchange with amiloride augments TGF and mimics the effect of nNOS inhibition. We hypothesized that increasing NaCl in the macula densa lumen raises macula densa intracellular pH (pH(i)) and activates nNOS.

METHODS

The thick ascending limb and a portion of the distal tubule with intact macula densa plaque adherent to the glomerulus were microdissected and perfused. Macula densa perfusate was changed from a low (10 mmol/L) to high NaCl solution (80 mmol/L) to mimic the conditions that induce TGF. Osmolality of both solutions was 180 mOsm, so that changing the solutions did not alter cell volume.

RESULTS

Macula densa pH(i) increased significantly from 7.0 +/- 0.5 to 7.8 +/- 0.6 when the perfusate was changed from low to high (P < 0.05; N= 5). When amiloride was added to inhibit Na(+)/H(+) exchange, the increase in pH(i) during TGF was blocked (N= 5). Fluorescence intensity of DAF-2, an NO-sensitive dye, increased by 28.8 +/- 4.1% after increasing luminal NaCl (N= 5), indicating an increase in NO production. In the presence of the Na(+)/H(+) exchanger inhibitor amiloride or the nNOS inhibitor 7-NI, the increase in NO induced by switching the macula densa perfusate from low to high was blunted. To study whether changes in pH(i) can directly alter NO production, we used nigericin, a K(+)/H(+) ionophore, to equilibrate luminal and intracellular pH. When macula densa pH was raised from 7.3 to 7.8 in the presence of 10(-5) mol/L nigericin in the low NaCl solution, fluorescence of DAF-2 in the macula densa increased by 17.9 +/- 1.3% (P < 0.01; N= 5). In the presence of 7-NI, the increase in NO induced by raising pH(i) was blocked (N= 5).

CONCLUSION

We concluded that macula densa pH(i) increases during TGF, and this increase in pH(i) activates nNos.