1
|
Xie HS, Huang JF, Lin QX, Chen YW, Chen GP, Lin QC. The role of exosomal circular RNA ZNF292 in intermittent hypoxia-induced AC16 cardiomyocytes injury. Sleep Breath 2024; 28:319-329. [PMID: 37726500 DOI: 10.1007/s11325-023-02920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/19/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Exosomes are involved in cell-to-cell communication in numerous diseases including cardiovascular diseases, neurological diseases. Little attention has been dedicated to exosomal circular RNAs in obstructive sleep apnea (OSA)-related cardiovascular diseases. The aim of this study was to explore the role of exosomal circular RNA ZNF292 (circZNF292) on AC16 cells exposure to intermittent hypoxia (IH). METHODS Exosome release inhibitor GW4869 was used to examine the effect of exosomes on IH-induced AC16 cells apoptosis. The expression of exosomal circZNF292 was detected by qRT-PCR in AC16 cells exposure to IH, and a luciferase reporter assay was conducted to confirm the connection between circZNF292 and miR-146a-5p. Exosomal circZNF292 was stably transfected with short hairpin RNAs (shRNAs) against circZNF292 and co-cultured with AC16 cells. The expression of miR-146a-5p and apoptosis-related protein was then measured to evaluate the effect of exosomal circZNF292. RESULTS We found that IH contributed to the AC16 cells apoptosis, and the administration of GW4869 increased the apoptosis of cardiomyocytes when exposed to IH. The expression of exosomal circZNF292 decreased and miR-146a-5p increased significantly in AC16 cells exposed to IH compared to normoxic conditions. Bioinformatics analysis predicted a circZNF292/miR-146a-5p axis in IH-induced cardiomyocytes apoptosis. The dual-luciferase reporter system validated the direct interaction of circZNF292 and miR-146a-5p. Knockdown of circZNF292 increased the expressions of miR-146a-5p and accelerated the AC16 cardiomyocytes apoptosis. CONCLUSIONS The findings of this study suggested a novel mechanism by which exosomes transmit intrinsic regulatory signals to the myocardium through the exosomal circZNF292/miR-146a-5p axis. This finding highlights the potential of targeting this pathway as a therapeutic approach for treating cardiovascular diseases associated with OSA.
Collapse
Affiliation(s)
- Han-Sheng Xie
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, NO 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jie-Feng Huang
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, NO 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Qiao-Xian Lin
- Department of Hematology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yue-Wen Chen
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Gong-Ping Chen
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, NO 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Qi-Chang Lin
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, NO 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China.
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| |
Collapse
|
2
|
Arnaud C, Billoir E, de Melo Junior AF, Pereira SA, O'Halloran KD, Monteiro EC. Chronic intermittent hypoxia-induced cardiovascular and renal dysfunction: from adaptation to maladaptation. J Physiol 2023; 601:5553-5577. [PMID: 37882783 DOI: 10.1113/jp284166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
Chronic intermittent hypoxia (CIH) is the dominant pathological feature of human obstructive sleep apnoea (OSA), which is highly prevalent and associated with cardiovascular and renal diseases. CIH causes hypertension, centred on sympathetic nervous overactivity, which persists following removal of the CIH stimulus. Molecular mechanisms contributing to CIH-induced hypertension have been carefully delineated. However, there is a dearth of knowledge on the efficacy of interventions to ameliorate high blood pressure in established disease. CIH causes endothelial dysfunction, aberrant structural remodelling of vessels and accelerates atherosclerotic processes. Pro-inflammatory and pro-oxidant pathways converge on disrupted nitric oxide signalling driving vascular dysfunction. In addition, CIH has adverse effects on the myocardium, manifesting atrial fibrillation, and cardiac remodelling progressing to contractile dysfunction. Sympatho-vagal imbalance, oxidative stress, inflammation, dysregulated HIF-1α transcriptional responses and resultant pro-apoptotic ER stress, calcium dysregulation, and mitochondrial dysfunction conspire to drive myocardial injury and failure. CIH elaborates direct and indirect effects in the kidney that initially contribute to the development of hypertension and later to chronic kidney disease. CIH-induced morphological damage of the kidney is dependent on TLR4/NF-κB/NLRP3/caspase-1 inflammasome activation and associated pyroptosis. Emerging potential therapies related to the gut-kidney axis and blockade of aryl hydrocarbon receptors (AhR) are promising. Cardiorenal outcomes in response to intermittent hypoxia present along a continuum from adaptation to maladaptation and are dependent on the intensity and duration of exposure to intermittent hypoxia. This heterogeneity of OSA is relevant to therapeutic treatment options and we argue the need for better stratification of OSA phenotypes.
Collapse
Affiliation(s)
- Claire Arnaud
- Université Grenoble-Alpes INSERM U1300, Laboratoire HP2, Grenoble, France
| | - Emma Billoir
- Université Grenoble-Alpes INSERM U1300, Laboratoire HP2, Grenoble, France
| | | | - Sofia A Pereira
- iNOVA4Health, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Emilia C Monteiro
- iNOVA4Health, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| |
Collapse
|
3
|
Costa GS, Julião-Silva LS, Belo VS, de Oliveira HCF, Chaves VE. A systematic review and meta-analyses on the effects of atorvastatin on blood pressure and heart rate. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 9:100-115. [PMID: 36138492 DOI: 10.1093/ehjcvp/pvac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
AIMS Considering the inconsistencies in the literature on the atorvastatin effect on blood pressure (BP), we performed these meta-analyses. METHODS AND RESULTS Through a search of the Excerpta Medica Database (EMBASE), PubMed, and Web of Science databases, 1412 articles were identified, from which 33 randomized clinical trials (RCT) and 44 pre-clinical were selected. Populations from RCT were stratified according to baseline BP and lipid levels. We performed meta-analyses of the effect of atorvastatin on systolic (SBP), diastolic and mean BP; heart rate (HR); HR variability, and baroreflex. Atorvastatin reduced SBP in the overall population (P = 0.05 vs. placebo; P = 0.03 vs. baseline), in normotensive and hyperlipidaemic (P = 0.04 vs. placebo; P = 0.0001 vs. baseline) and in hypertensive and hyperlipidaemic (P = 0.02 vs. placebo; P = 0.008 vs. baseline) individuals in parallel RCT, but it did not affect SBP in normotensive and normolipidaemic individuals (P = 0.51 vs. placebo; P = 0.4 vs. baseline). Although an effect of atorvastatin was detected in hyperlipidaemic individuals, the meta-regression coefficient for the association of low density lipoprotein (LDL)-cholesterol reduction with SBP reduction in the overall population demonstrated that SBP reduction is not dependent on the changes in LDL-cholesterol. A meta-analysis of preclinical reports demonstrated that SBP was reduced in atorvastatin-treated hypertensive and normolipidaemic rats (spontaneously hypertensive rats: P < 0.00001), but not in normotensive and normolipidaemic rats (control rats: P = 0.97). Atorvastatin also reduced the HR in spontaneously hypertensive rat. CONCLUSION Atorvastatin lowers BP independent of LDL-cholesterol levels. Additional studies are needed to estimate the involvement of the autonomic nervous system in the BP-lowering effect of atorvastatin.
Collapse
Affiliation(s)
- Gabriel S Costa
- Laboratory of Physiology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| | - Letícia S Julião-Silva
- Laboratory of Physiology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| | - Vinícius S Belo
- Laboratory of Parasitology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| | - Helena C F de Oliveira
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, Monteiro Lobato Street, 255, 13.083-862, Campinas, São Paulo, Brazil
| | - Valéria E Chaves
- Laboratory of Physiology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| |
Collapse
|
4
|
L-Citrulline Supplementation Reduces Blood Pressure and Myocardial Infarct Size under Chronic Intermittent Hypoxia, a Major Feature of Sleep Apnea Syndrome. Antioxidants (Basel) 2022; 11:antiox11122326. [PMID: 36552534 PMCID: PMC9774116 DOI: 10.3390/antiox11122326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
Intermittent hypoxia (IH) is a landmark of obstructive sleep apnea (OSA) at the core of the cardiovascular consequences of OSA. IH triggers oxidative stress, a major underlying mechanism for elevated blood pressure (BP) and increased infarct size. L-citrulline is an amino acid that has been demonstrated to be protective of the cardiovascular system and exert pleiotropic effects. Therefore, we tested the impact of citrulline supplementation on IH-induced increase in BP and infarct size. Four groups of rats exposed to normoxia (N) or IH [14 days (d), 8 h/day, 30 s-O2 21%/30 s-O2 5%] and were supplemented or not with citrulline (1 g·kg-1·d-1). After 14 d, BP was measured, and hearts were submitted to global ischemia-reperfusion to measure infarct size. Histological and biochemical analyses were conducted on hearts and aorta to assess oxidative stress. Citrulline significantly reduced BP (-9.92%) and infarct size (-18.22%) under IH only. In the aorta, citrulline supplementation significantly decreased superoxide anion and nitrotyrosine levels under IH and abolished the IH-induced decrease in nitrite. Citrulline supplementation significantly decreased myocardial superoxide anion levels and xanthine oxidase enzyme activity under IH. Citrulline shows a cardioprotective capacity by limiting IH-induced pro-oxidant activity. Our results suggest that citrulline might represent a new pharmacological strategy in OSA patients with high cardiovascular risk.
Collapse
|
5
|
Luo B, Li Y, Zhu M, Cui J, Liu Y, Liu Y. Intermittent Hypoxia and Atherosclerosis: From Molecular Mechanisms to the Therapeutic Treatment. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1438470. [PMID: 35965683 PMCID: PMC9365608 DOI: 10.1155/2022/1438470] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
Intermittent hypoxia (IH) has a dual nature. On the one hand, chronic IH (CIH) is an important pathologic feature of obstructive sleep apnea (OSA) syndrome (OSAS), and many studies have confirmed that OSA-related CIH (OSA-CIH) has atherogenic effects involving complex and interacting mechanisms. Limited preventive and treatment methods are currently available for this condition. On the other hand, non-OSA-related IH has beneficial or detrimental effects on the body, depending on the degree, duration, and cyclic cycle of hypoxia. It includes two main states: intermittent hypoxia in a simulated plateau environment and intermittent hypoxia in a normobaric environment. In this paper, we compare the two types of IH and summarizes the pathologic mechanisms and research advances in the treatment of OSA-CIH-induced atherosclerosis (AS), to provide evidence for the systematic prevention and treatment of OSAS-related AS.
Collapse
Affiliation(s)
- Binyu Luo
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yiwen Li
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Mengmeng Zhu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Jing Cui
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yanfei Liu
- The Second Department of Gerontology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yue Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| |
Collapse
|
6
|
Harki O, Boete Q, Pépin JL, Arnaud C, Belaidi E, Faury G, Khouri C, Briançon-Marjollet A. Intermittent hypoxia-related alterations in vascular structure and function: a systematic review and meta-analysis of rodent data. Eur Respir J 2021; 59:13993003.00866-2021. [PMID: 34413154 DOI: 10.1183/13993003.00866-2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/25/2021] [Indexed: 12/09/2022]
Abstract
Obstructive Sleep Apnea and the related intermittent hypoxia (IH) are widely recognised as risk factors for incident cardiovascular diseases. Numerous studies support the deleterious vascular impact of IH in rodents but an overall interpretation is challenging owing to heterogeneity in rodent species investigated and the severity and duration of IH exposure.To clarify this major issue, we conducted a systematic review and meta-analysis to quantify the impact of IH on systemic artery structure and function depending on the different IH exposure designs.We searched PubMed, Embase and Web of Sciences and included 125 articles in a meta-analysis, among them 112 using wild-type rodents and 13 using Apolipoprotein E knock-out mice. We used the standardised mean difference (SMD) to compare results between studies.IH significantly increased mean arterial pressure (+13.90 mmHg (95% CI [11.88; 15.92]), systolic and diastolic blood pressure. Meta-regressions showed that mean arterial pressure change was associated with strain and year of publication. IH altered vasodilation in males but not in females, and increased endothelin-1-induced, but not phenylephrine-induced, vasoconstriction. Intima-media thickness significantly increased upon IH exposure (SMD 1.10 [0.58; 1.62], absolute values: +5.23 (2.81-7.84)). This increase was observed in mice but not in rats, and was negatively associated with age. Finally IH increased atherosclerotic plaque size in ApoE-/- mice (SMD 1.08 [0.80; 1.37]).To conclude, our meta-analysis established that IH, independently of other confounders, has a strong effect on vascular structure and physiology. Our findings support the interest of identifying and treating sleep apnea in routine cardiology practice.
Collapse
Affiliation(s)
- Olfa Harki
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Quentin Boete
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Claire Arnaud
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Elise Belaidi
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Gilles Faury
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Charles Khouri
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France.,Pharmacovigilance Unit & Clinical Pharmacology Department, Grenoble Alpes University Hospital, Grenoble, France.,Co-last authors have equally contributed to the work
| | - Anne Briançon-Marjollet
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France .,Co-last authors have equally contributed to the work
| |
Collapse
|
7
|
Zhang XB, Cheng HJ, Yuan YT, Chen Y, Chen YY, Chiu KY, Zeng HQ. Atorvastatin attenuates intermittent hypoxia-induced myocardial oxidative stress in a mouse obstructive sleep apnea model. Aging (Albany NY) 2021; 13:18870-18878. [PMID: 34289453 PMCID: PMC8351704 DOI: 10.18632/aging.203339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022]
Abstract
Chronic intermittent hypoxia (CIH), a hallmark of obstructive sleep apnea (OSA), is associated with various cardiovascular diseases. In the present study, we assessed the effect of the lipid reducing agent atorvastatin on CIH-induced myocardial oxidative stress and apoptosis in a mouse OSA model. Forty-eight C57BL/6J mice were evenly divided among normoxia + vehicle, normoxia + atorvastatin, CIH + vehicle, and CIH + atorvastatin groups. CIH consisted of a hypoxia-reoxygenation cycle in which oxygen concentrations fluctuated from 21% to 6% and back over two minutes for 8 hours each day (30 events/hour). CIH exposure continued for 12 weeks. Atorvastatin (5 mg/kg) was administered from week 6 through the end of the experiment. CIH increased malondialdehyde levels and decreased superoxide dismutase activity, total antioxidant capacity, and nuclear factor erythroid 2-related factor 2 levels in cardiac tissue, indicating a reduction in antioxidant activity. Atorvastatin significantly reversed those effects (p < 0.05). CIH also increased B-cell lymphoma 2-associated protein X and cleaved caspased-3 levels as well as the myocardial apoptotic rate, as indicated by terminal deoxynucleotidyl transferase dUTP nick-end labeling. Atorvastatin had no effect on those changes (p > 0.05). Thus, atorvastatin administration exerts antioxidant but not anti-apoptotic effects after CIH and may therefore have therapeutic potential in OSA patients with cardiovascular comorbidities.
Collapse
Affiliation(s)
- Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| | - Hui-Juan Cheng
- Department of Medical Affairs, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| | - Ya-Ting Yuan
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| | - Yi-Yuan Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| | - Kam Yu Chiu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| | - Hui-Qing Zeng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian Province, People's Republic of China
| |
Collapse
|
8
|
Sánchez-de-la-Torre M, Barbé F. Exploring the underlying prothrombotic mechanisms promoted by intermittent hypoxia: a potential therapeutic target? Sleep 2021; 44:6205722. [PMID: 33835163 DOI: 10.1093/sleep/zsab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Manuel Sánchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Group of Traslational Research in Respiratory Medicine, Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| |
Collapse
|
9
|
Chen Q, Lin G, Chen Y, Li C, Wu L, Hu X, Lin Q. miR-3574 ameliorates intermittent hypoxia-induced cardiomyocyte injury through inhibiting Axin1. Aging (Albany NY) 2021; 13:8068-8077. [PMID: 33582657 PMCID: PMC8034950 DOI: 10.18632/aging.202480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/31/2020] [Indexed: 12/11/2022]
Abstract
Objective: miRNAs play critical roles in the regulation of many cardiovascular diseases. However, its role and potential mechanism in cardiac injury caused by obstructive sleep apnea (OSA) remain poorly elucidated. In the present study, we aimed to investigate the effects of miR-3574 on cardiomyocyte injury under intermittent hypoxia (IH). Results: We confirmed that IH inhibited cell viability, induced cell apoptosis and suppressed miR-3574 expression in the H9c2. miR-3574 overexpression could ameliorate the effects of IH on the cell viability and cell apoptosis in the H9c2. Axin1 was a target gene of miR-3574, and miR-3574 overexpression reduced the expression of Axin1. miR-3574 could inhibit the IH-induced cardiomyocyte injury via downregulating Axin1. However, Axin1 could partially reverse these effects of miR-3574. Conclusion: Our study first reveals that miR-3574 could alleviate IH-induced cardiomyocyte injury by targeting Axin1, which may function as a novel and promising therapy target for OSA-associated cardiovascular diseases. Methods: H9c2 were exposed to IH condition. CCK-8 assay was applied to determine cell viability of H9c2. qRT-PCR was conducted to measure the expression level of mRNA and miRNA. Western blot assay was then performed to detect the protein levels. Finally, we used dual-luciferase reporter assay identify the potential target of miR-3574.
Collapse
Affiliation(s)
- Qingshi Chen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China.,Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Taijiang, Fuzhou 350005, China
| | - Guofu Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Taijiang, Fuzhou 350005, China
| | - Yongfa Chen
- The First Affiliated Hospital of Xiamen University, Siming, Xiamen 361001, China
| | - Chaowei Li
- The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China
| | - Lizhen Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China
| | - Xin Hu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China
| | - Qichang Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Taijiang, Fuzhou 350005, China
| |
Collapse
|
10
|
Moulin S, Arnaud C, Bouyon S, Pépin JL, Godin-Ribuot D, Belaidi E. Curcumin prevents chronic intermittent hypoxia-induced myocardial injury. Ther Adv Chronic Dis 2020; 11:2040622320922104. [PMID: 32637058 PMCID: PMC7315663 DOI: 10.1177/2040622320922104] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Chronic intermittent hypoxia (IH), the hallmark feature of obstructive sleep apnoea syndrome, contributes to infarct size enhancement after myocardial ischemia–reperfusion (I/R). Curcumin (Curc), the natural pigment of Curcuma longa, has been demonstrated to be beneficial in the context of myocardial injury. In this study, we assessed the effects of Curc on the maladaptive cardiac response to IH, and particularly on IH-induced hypoxia inducible factor-1 (HIF-1) expression, oxidative stress, inflammation, endoplasmic reticulum (ER) stress and apoptosis. Methods: Swiss/SV129 mice were exposed to normoxia or IH (21–5% FiO2, 60 s cycles, 8 h per day, for 21 days) and treated orally with Curc (100 mg kg−1
day−1, oral gavage) or its vehicle. Mice were then either euthanised for heart sampling in order to perform biochemical and histological analysis, or subjected to an in vivo ischemia-reperfusion protocol in order to measure infarct size. Results: IH increased nuclear HIF-1α expression and superoxide anion (O2.–) production as well as nuclear factor kappa B (NF-kB) p65, glucose-regulated protein (Grp78) and C/EBP homologous protein (CHOP) expression. IH also induced apoptosis and increased infarct size after I/R . The IH-induced HIF-1 activation, oxidative stress, inflammation, ER stress and apoptosis were abolished by chronic Curc treatment. Curc also significantly decreased infarct size only in mice exposed to IH. Conclusion: Curc prevents IH-induced myocardial cell death signalling. Curc might be used as a combined therapy with continuous positive airway pressure in sleep apnoea patients with high cardiovascular risk.
Collapse
Affiliation(s)
- Sophie Moulin
- Université Grenoble Alpes-HP2-Grenoble F-38042, France / INSERM, U1042-Grenoble F38042, France
| | - Claire Arnaud
- Université Grenoble Alpes-HP2-Grenoble F-38042, France / INSERM, U1042-Grenoble F38042, France
| | - Sophie Bouyon
- Université Grenoble Alpes-HP2-Grenoble F-38042, France / INSERM, U1042-Grenoble F38042, France
| | - Jean-Louis Pépin
- Université Grenoble Alpes-HP2-Grenoble F-38042, France / INSERM, U1042-Grenoble F38042, France / Centre Hospitalier Universitaire des Alpes, Grenoble F38042, France
| | - Diane Godin-Ribuot
- Université Grenoble Alpes-HP2-Grenoble F-38042, France / INSERM, U1042-Grenoble F38042, France
| | - Elise Belaidi
- University Grenoble Alpes, Grenoble, France INSERM, U1042, Grenoble, France
| |
Collapse
|
11
|
Bangash A, Wajid F, Poolacherla R, Mim FK, Rutkofsky IH. Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association. Cureus 2020; 12:e8241. [PMID: 32582500 PMCID: PMC7306640 DOI: 10.7759/cureus.8241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Obstructive sleep apnea (OSA) is defined as episodes of hypopnea or apnea, which leads to a partial or complete block of airways. Hypertension, on the other hand, is defined as an increase in systemic arterial blood pressure to a certain threshold. OSA and hypertension share many common factors in pathophysiology, such as gender, obesity, unhealthy lifestyle, impaired quality of sleep, renin-angiotensin system, and increased fluid distribution. In order to manage our patients effectively, we need to explore further the correlation between the two conditions.
Collapse
Affiliation(s)
- Amna Bangash
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Fareha Wajid
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Raju Poolacherla
- Anesthesia and Perioperative Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.,Pediatric Anesthesia and Pain, Western University, London, CAN
| | - Fatiha Kabir Mim
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| |
Collapse
|
12
|
Ayas NT, Foster GE, Shah N, Floras J, Laher I. Could Adjunctive Pharmacology Mitigate Cardiovascular Consequences of Obstructive Sleep Apnea? Am J Respir Crit Care Med 2020; 200:551-555. [PMID: 30875238 DOI: 10.1164/rccm.201811-2097pp] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Najib T Ayas
- Sleep Disorders Program.,Division of Respiratory Medicine and.,Division of Critical Care Medicine, Department of Medicine, and.,Canadian Sleep and Circadian Network and
| | - Glen E Foster
- Canadian Sleep and Circadian Network and.,Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Neomi Shah
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - John Floras
- Division of Cardiology, Department of Medicine, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Sleep and Circadian Network and
| |
Collapse
|
13
|
Affiliation(s)
| | - Naima Covassin
- Department of Cardiovascular Diseases (N.C., V.K.S.), Mayo Clinic, Rochester, MN
| | - Virend K Somers
- Department of Cardiovascular Diseases (N.C., V.K.S.), Mayo Clinic, Rochester, MN
| |
Collapse
|
14
|
Patel AR, Patel AR, Singh S, Singh S, Khawaja I. The Association of Obstructive Sleep Apnea and Hypertension. Cureus 2019; 11:e4858. [PMID: 31410341 PMCID: PMC6684296 DOI: 10.7759/cureus.4858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. Hypertension (HTN) is defined by the presence of a chronic elevation of systemic arterial pressure above a certain threshold value (≥140 mm Hg systolic or ≥90 mm Hg diastolic). On the surface, OSA and HTN appear very different from one another. Despite this, they share several common risk factors including obesity, male gender, and advancing age. In 2003, the Seventh Joint National Committee (JNC VII) recognized OSA as a secondary cause of HTN. As physicians, our goal is to understand the OSA-HTN association better through academic study regarding its epidemiology, its pathophysiology, and its treatment.
Collapse
Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| |
Collapse
|
15
|
miR-146a-5p Mediates Intermittent Hypoxia-Induced Injury in H9c2 Cells by Targeting XIAP. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:6581217. [PMID: 31205587 PMCID: PMC6530234 DOI: 10.1155/2019/6581217] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/31/2019] [Indexed: 12/16/2022]
Abstract
MicroRNAs (miRNAs) have emerged as key modulators in the pathophysiologic processes of cardiovascular diseases. However, its function in cardiac injury induced by obstructive sleep apnea (OSA) remains unknown. The aim of the current study was to identify the effect and potential molecular mechanism of miR-146a-5p in intermittent hypoxia(IH)- induced myocardial damage. We exposed H9c2 cells to IH condition; the expression levels of miR-146a-5p were detected by RT-qPCR. Cell viability, cell apoptosis, and the expressions of apoptosis-associated proteins were assessed via Cell Counting Kit-8 (CCK-8), flow cytometry, and western blotting, respectively. Target genes of miR-146a-5p were confirmed by dual-luciferase reporter assay. IH remarkably lowered viability but enhanced cell apoptosis. Concomitantly, the miR-146a-5p expression level was increased in H9c2 cells after IH. Subsequent experiments showed that IH-induced injury was alleviated through miR-146a-5p silence. X-linked inhibitor of apoptosis protein (XIAP) was predicted by bioinformatics analysis and further confirmed as a direct target gene of miR-146a-5p. Surprisingly, the effect of miR-146a-5p inhibition under IH may be reversed by downregulating XIAP expression. In conclusion, our results demonstrated that miR-146a-5p could attenuate viability and promote the apoptosis of H9c2 by targeting XIAP, thus aggravating the H9c2 cell injury induced by IH, which could enhance our understanding of the mechanisms for OSA-associated cardiac injury.
Collapse
|
16
|
Ren J, Liu W, Li GC, Jin M, You ZX, Liu HG, Hu Y. Atorvastatin Attenuates Myocardial Hypertrophy Induced by Chronic Intermittent Hypoxia In Vitro Partly through miR-31/PKCε Pathway. Curr Med Sci 2018; 38:405-412. [PMID: 30074205 DOI: 10.1007/s11596-018-1893-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/03/2018] [Indexed: 02/07/2023]
Abstract
Atorvastatin is proven to ameliorate cardiac hypertrophy induced by chronic intermittent hypoxia (CIH). However, little is known about the mechanism by which atorvastatin modulates CIH-induced cardiac hypertrophy, and whether specific hypertrophyrelated microRNAs are involved in the modulation. MiR-31 plays key roles in the development of cardiac hypertrophy induced by ischemia/hypoxia. This study examined whether miR-31 was involved in the protective role of atorvastatin against CIH-induced myocardial hypertrophy. H9c2 cells were subjected to 8-h intermittent hypoxia per day in the presence or absence of atorvastatin for 5 days. The size of cardiomyocytes, and the expression of caspase 3 and miR-31 were determined by Western blotting and RT-PCR, respectively. MiR-31 mimic or Ro 31-8220, a specific inhibitor of protein kinase C epsilon (PKCε), was used to determine the role of miR-31 in the anti-hypertrophic effect of atorvastatin on cardiomyocytes. PKCε in the cardiomyocytes with miR-31 upregulation or downregulation was detected using RT-PCR and Western blotting. The results showed that CIH induced obvious enlargement of cardiomyocytes, which was paralleled with increased atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and slow/beta cardiac myosin heavy-chain (MYH7) mRNA levels. All these changes were reversed by the treatment with atorvastatin. Meanwhile, miR-31 was increased by CIH in vitro. Of note, the atorvastatin pretreatment significantly increased the mRNA and protein expression of PKCe and decreased that of miR-31. Moreover, overexpression of miR-31 abolished the anti-hypertrophic effect of atorvastatin on cardiomyocytes. Upregulation and downregulation of miR-31 respectively decreased and increased the mRNA and protein expression of PKCε. These results suggest that atorvastatin provides the cardioprotective effects against CIH probably via up-regulating PKCε and down-regulating miR-31.
Collapse
Affiliation(s)
- Jie Ren
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Liu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430010, China
| | - Guang-Cai Li
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meng Jin
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhen-Xi You
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hui-Guo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Yi Hu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430010, China.
| |
Collapse
|
17
|
Impairment of vascular strain in patients with obstructive sleep apnea. PLoS One 2018; 13:e0193397. [PMID: 29489881 PMCID: PMC5831412 DOI: 10.1371/journal.pone.0193397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular diseases. Aim of this present study was to evaluate and extend recent research on the influence of obstructive sleep apnea on vascular strain. Methods A total number of 98 patients were integrated in the study. Patients were grouped according to the Apnea-Hypopnea-Index (AHI) in patients with mild-to-moderate OSA (5/h ≤ AHI < 30/h), severe OSA (AHI ≥ 30/h) and controls (AHI < 5/h). Groups were matched in age, body-mass-index and cardiovascular risks. Vascular strain of common carotid arteries was assessed by ultrasound speckle-tracking. A minor group of 30 patients and controls further underwent assessment of vascular strain of brachial and femoral arteries. Additionally, all patients underwent blood testing to reveal potential influences of inflammatory markers on arterial stiffness. In additional analysis we examined the effect of statin therapy on vascular strain. Results Patients with OSA showed significantly reduced values of vascular strain of common carotid arteries. Radial and circumferential strains were significantly lower in both patients with mild-to-moderate (p = .05) and patients with severe OSA (p = .001) compared to control. Vascular strain parameters of brachial and femoral arteries showed no consistent results. There were no significant correlations of inflammatory markers with vascular strain parameters. No significant differences in vascular strain were detected between statin and non-statin groups. Conclusion Patients with OSA show significantly reduced vascular strain assessed by ultrasound-based speckle-tracking. Vascular stiffness increases with the severity of the disease. Target vessels to assess vascular strain in patients with OSA are common carotid arteries, whereas other sites of the arterial tree are not reliable. No significant impact of current statin therapy on vascular strain was found. Further studies are needed to evaluate potential benefit of statins in secondary prevention of atherosclerosis in OSA.
Collapse
|
18
|
Arnaud C, Bouyon S, Recoquillon S, Brasseur S, Lemarié E, Briançon-Marjollet A, Gonthier B, Toral M, Faury G, Martinez MC, Andriantsitohaina R, Pepin JL. Nonmuscle Myosin Light Chain Kinase: A Key Player in Intermittent Hypoxia-Induced Vascular Alterations. J Am Heart Assoc 2018; 7:JAHA.117.007893. [PMID: 29371201 PMCID: PMC5850262 DOI: 10.1161/jaha.117.007893] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Obstructive sleep apnea is characterized by repetitive pharyngeal collapses during sleep, leading to intermittent hypoxia (IH), the main contributor of obstructive sleep apnea–related cardiovascular morbidity. In patients and rodents with obstructive sleep apnea exposed to IH, vascular inflammation and remodeling, endothelial dysfunction, and circulating inflammatory markers are linked with IH severity. The nonmuscle myosin light chain kinase (nmMLCK) isoform contributes to vascular inflammation and oxidative stress in different cardiovascular and inflammatory diseases. Thus, in the present study, we hypothesized that nmMLCK plays a key role in the IH‐induced vascular dysfunctions and inflammatory remodeling. Methods and Results Twelve‐week‐old nmMLCK+/+ or nmMLCK−/− mice were exposed to 14‐day IH or normoxia. IH was associated with functional alterations characterized by an elevation of arterial blood pressure and stiffness and perturbations of NO signaling. IH caused endothelial barrier dysfunction (ie, reduced transendothelial resistance in vitro) and induced vascular oxidative stress associated with an inflammatory remodeling, characterized by an increased intima‐media thickness and an increased expression and activity of inflammatory markers, such as interferon‐γ and nuclear factor‐κB, in the vascular wall. Interestingly, nmMLCK deletion prevented all IH‐induced functional and structural alterations, including the restoration of NO signaling, correction of endothelial barrier integrity, and reduction of both oxidative stress and associated inflammatory response. Conclusions nmMLCK is a key mechanism in IH‐induced vascular oxidative stress and inflammation and both functional and structural remodeling.
Collapse
Affiliation(s)
- Claire Arnaud
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France .,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - Sophie Bouyon
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - Sylvain Recoquillon
- Université d'Angers Université Bretagne Loire, Angers, France.,INSERM UMR1063, Angers, France
| | - Sandrine Brasseur
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - Emeline Lemarié
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - Anne Briançon-Marjollet
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - Brigitte Gonthier
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - Marta Toral
- Université d'Angers Université Bretagne Loire, Angers, France.,INSERM UMR1063, Angers, France
| | - Gilles Faury
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France
| | - M Carmen Martinez
- Université d'Angers Université Bretagne Loire, Angers, France.,INSERM UMR1063, Angers, France
| | | | - Jean-Louis Pepin
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France.,Laboratoire HP2, INSERM U1042, Grenoble, France.,Laboratoire d'Exploration Fonctionnelle Cardiovasculaire et Respiratoire, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| |
Collapse
|
19
|
Gautier-Veyret E, Pépin JL, Stanke-Labesque F. Which place of pharmacological approaches beyond continuous positive airway pressure to treat vascular disease related to obstructive sleep apnea? Pharmacol Ther 2017; 186:45-59. [PMID: 29277633 DOI: 10.1016/j.pharmthera.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, occurring during sleep, leading to chronic intermittent hypoxia (IH), which harms the cardiovascular system. OSA is associated with both functional and structural vascular alterations that contribute to an increased prevalence of fatal and non-fatal cardiovascular events. OSA is a heterogeneous disease with respect to the severity of hypoxia, the presence of daytime symptoms, obesity, and cardiovascular comorbidities. Various clusters of OSA phenotypes have been described leading to more highly personalized treatment. The aim of this review is to describe the various therapeutic strategies including continuous positive airway pressure (CPAP), oral appliances, surgery, weight loss, and especially pharmacological interventions that have been evaluated to reduce vascular alterations in both OSA patients and preclinical animal models. Conventional therapies, predominantly CPAP, have a limited impact on vascular alterations in the presence of co-morbidities. A better knowledge of pharmacological therapies targeting IH-induced vascular alterations will facilitate the use of combined therapies and is crucial for designing clinical trials in well-defined OSA phenotypes.
Collapse
Affiliation(s)
- Elodie Gautier-Veyret
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France.
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
| | - Françoise Stanke-Labesque
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
| |
Collapse
|
20
|
Briançon-Marjollet A, Monneret D, Henri M, Joyeux-Faure M, Totoson P, Cachot S, Faure P, Godin-Ribuot D. Intermittent hypoxia in obese Zucker rats: cardiometabolic and inflammatory effects. Exp Physiol 2016; 101:1432-1442. [DOI: 10.1113/ep085783] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/30/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Anne Briançon-Marjollet
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
| | - Denis Monneret
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
- CHU Institut de Biologie et Pathologies; F-38043 Grenoble France
| | - Marion Henri
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
| | - Marie Joyeux-Faure
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
| | - Perle Totoson
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
| | - Sandrine Cachot
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
| | - Patrice Faure
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
- CHU Institut de Biologie et Pathologies; F-38043 Grenoble France
| | - Diane Godin-Ribuot
- Univ Grenoble Alpes; HP2, F-38041 Grenoble Cedex France
- INSERM U1042; F-38041 Grenoble Cedex France
| |
Collapse
|
21
|
Targeting the ROS-HIF-1-endothelin axis as a therapeutic approach for the treatment of obstructive sleep apnea-related cardiovascular complications. Pharmacol Ther 2016; 168:1-11. [PMID: 27492897 DOI: 10.1016/j.pharmthera.2016.07.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 07/08/2016] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is now recognized as an independent and important risk factor for cardiovascular diseases such as hypertension, coronary heart disease, heart failure and stroke. Clinical and experimental data have confirmed that intermittent hypoxia is a major contributor to these deleterious consequences. The repetitive occurrence of hypoxia-reoxygenation sequences generates significant amounts of free radicals, particularly in moderate to severe OSA patients. Moreover, in addition to hypoxia, reactive oxygen species (ROS) are potential inducers of the hypoxia inducible transcription factor-1 (HIF-1) that promotes the transcription of numerous adaptive genes some of which being deleterious for the cardiovascular system, such as the endothelin-1 gene. This review will focus on the involvement of the ROS-HIF-1-endothelin signaling pathway in OSA and intermittent hypoxia and discuss current and potential therapeutic approaches targeting this pathway to treat or prevent cardiovascular disease in moderate to severe OSA patients.
Collapse
|
22
|
Pleiotropic effects of statins: new therapeutic targets in drug design. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:695-712. [PMID: 27146293 DOI: 10.1007/s00210-016-1252-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/25/2016] [Indexed: 12/13/2022]
Abstract
The HMG Co-enzyme inhibitors and new lipid-modifying agents expand their new therapeutic target options in the field of medical profession. Statins have been described as the most effective class of drugs to reduce serum cholesterol levels. Since the discovery of the first statin nearly 30 years ago, these drugs have become the main therapeutic approach to lower cholesterol levels. The present scientific research demonstrates numerous non-lipid modifiable effects of statins termed as pleiotropic effects of statins, which could be beneficial for the treatment of various devastating disorders. The most important positive effects of statins are anti-inflammatory, anti-proliferative, antioxidant, immunomodulatory, neuroprotective, anti-diabetes, and antithrombotic, improving endothelial dysfunction and attenuating vascular remodeling besides many others which are discussed under the scope of this review. In particular, inhibition of Rho and its downstream target, Rho-associated coiled-coil-containing protein kinase (ROCK), and their agonistic action on peroxisome proliferator-activated receptors (PPARs) can be viewed as the principle mechanisms underlying the pleiotropic effects of statins. With gradually increasing knowledge of new therapeutic targets of statins, their use has also been advocated in chronic inflammatory disorders for example rheumatoid arthritis (RA) and in systemic lupus erythematosus (SLE). In the scope of review, we highlight statins and their pleiotropic effects with reference to their harmful and beneficial effects as a novel approach for their use in the treatment of devastating disorders. Graphical abstract Pleiotropic effect of statins.
Collapse
|
23
|
Belaidi E, Thomas A, Bourdier G, Moulin S, Lemarié E, Levy P, Pépin JL, Korichneva I, Godin-Ribuot D, Arnaud C. Endoplasmic reticulum stress as a novel inducer of hypoxia inducible factor-1 activity: its role in the susceptibility to myocardial ischemia-reperfusion induced by chronic intermittent hypoxia. Int J Cardiol 2016; 210:45-53. [PMID: 26922713 DOI: 10.1016/j.ijcard.2016.02.096] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent disease and a risk factor for myocardial infarction expansion in humans. Intermittent hypoxia (IH) is known to be the most important OSA feature in terms of cardiovascular morbi-mortality. Since ER stress and HIF-1 are known to be involved in cardiomyocyte life or death, this study investigates the role of ER stress on HIF-1 activation in myocardial susceptibility to ischemia-reperfusion (I/R) induced by IH. METHODS C57Bl6J, HIF-1α(+/-) and their respective control mice were exposed to 14 days of IH (21-5% FiO2, 60 scycle, 8h/day). Myocardial inter-organelle calcium exchanges, ER stress and HIF-1 activity were investigated and in vivo I/R was performed to measure infarct size. In additional groups, tauroursodeoxycholic acid (TUDCA, 75 mg·kg(-1)), an ER stress inhibitor, was administered daily during exposure. RESULTS In C57Bl6J mice, chronic IH induced an increase in ER-Ca(2+) content, ER stress markers and HIF-1 activity, associated with an enhanced infarct size (33.7 ± 9.4 vs. 61.0 ± 5.6% in N and IH, respectively, p<0.05). IH failed to increase infarct size in HIF-1α deficient mice (42.4 ± 2.7 and 24.7 ± 3.4% N and IH, respectively). Finally, TUDCA totally abolished the IH-induced increase in HIF-1 activity (1.3 ± 0.04 vs. 0.14 ± 0.02 fold increase in IH vs. IH-TUDCA respectively, p<0.0001) and in infarct size (55.5 ± 7.6 vs. 49.9 ± 3.0 in N-TUDCA and IH-TUDCA, respectively). CONCLUSION This novel regulatory mechanism of HIF-1 activity by ER stress should be considered as a potential diagnostic tool for cardiovascular complications in OSA patients as well as a therapeutic target to limit myocardial ischemic damage.
Collapse
Affiliation(s)
- Elise Belaidi
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France.
| | - Amandine Thomas
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Guillaume Bourdier
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Sophie Moulin
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Emeline Lemarié
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Patrick Levy
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Jean-Louis Pépin
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Irina Korichneva
- Université Picardie, Laboratoire de biologie cellulaire moléculaire, Amiens 80000, France
| | - Diane Godin-Ribuot
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| | - Claire Arnaud
- Université Grenoble Alpes, Laboratoire HP2, Grenoble F-38042, France; INSERM, U1042, Grenoble F-38042, France
| |
Collapse
|
24
|
The impact of chronic intermittent hypoxia on hematopoiesis and the bone marrow microenvironment. Pflugers Arch 2016; 468:919-32. [PMID: 26856724 PMCID: PMC4842224 DOI: 10.1007/s00424-016-1797-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/21/2015] [Accepted: 01/26/2016] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder which is associated with patient morbidity and an elevated risk of developing hypertension and cardiovascular diseases. There is ample evidence for the involvement of bone marrow (BM) cells in the pathophysiology of cardiovascular diseases but a connection between OSA and modulation of the BM microenvironment had not been established. Here, we studied how chronic intermittent hypoxia (CIH) affected hematopoiesis and the BM microenvironment, in a rat model of OSA. We show that CIH followed by normoxia increases the bone marrow hypoxic area, increases the number of multipotent hematopoietic progenitors (CFU assay), promotes erythropoiesis, and increases monocyte counts. In the BM microenvironment of CIH-subjected animals, the number of VE-cadherin-expressing blood vessels, particularly sinusoids, increased, accompanied by increased smooth muscle cell coverage, while vWF-positive vessels decreased. Molecularly, we investigated the expression of endothelial cell-derived genes (angiocrine factors) that could explain the cellular phenotypes. Accordingly, we observed an increase in colony-stimulating factor 1, vascular endothelium growth factor, delta-like 4, and angiopoietin-1 expression. Our data shows that CIH induces vascular remodeling in the BM microenvironment, which modulates hematopoiesis, increasing erythropoiesis, and circulating monocytes. Our study reveals for the first time the effect of CIH in hematopoiesis and suggests that hematopoietic changes may occur in OSA patients.
Collapse
|
25
|
Bourdier G, Flore P, Sanchez H, Pepin JL, Belaidi E, Arnaud C. High-intensity training reduces intermittent hypoxia-induced ER stress and myocardial infarct size. Am J Physiol Heart Circ Physiol 2015; 310:H279-89. [PMID: 26566725 DOI: 10.1152/ajpheart.00448.2015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/09/2015] [Indexed: 12/25/2022]
Abstract
Chronic intermittent hypoxia (IH) is described as the major detrimental factor leading to cardiovascular morbimortality in obstructive sleep apnea (OSA) patients. OSA patients exhibit increased infarct size after a myocardial event, and previous animal studies have shown that chronic IH could be the main mechanism. Endoplasmic reticulum (ER) stress plays a major role in the pathophysiology of cardiovascular disease. High-intensity training (HIT) exerts beneficial effects on the cardiovascular system. Thus, we hypothesized that HIT could prevent IH-induced ER stress and the increase in infarct size. Male Wistar rats were exposed to 21 days of IH (21-5% fraction of inspired O2, 60-s cycle, 8 h/day) or normoxia. After 1 wk of IH alone, rats were submitted daily to both IH and HIT (2 × 24 min, 15-30m/min). Rat hearts were either rapidly frozen to evaluate ER stress by Western blot analysis or submitted to an ischemia-reperfusion protocol ex vivo (30 min of global ischemia/120 min of reperfusion). IH induced cardiac proapoptotic ER stress, characterized by increased expression of glucose-regulated protein kinase 78, phosphorylated protein kinase-like ER kinase, activating transcription factor 4, and C/EBP homologous protein. IH-induced myocardial apoptosis was confirmed by increased expression of cleaved caspase-3. These IH-associated proapoptotic alterations were associated with a significant increase in infarct size (35.4 ± 3.2% vs. 22.7 ± 1.7% of ventricles in IH + sedenary and normoxia + sedentary groups, respectively, P < 0.05). HIT prevented both the IH-induced proapoptotic ER stress and increased myocardial infarct size (28.8 ± 3.9% and 21.0 ± 5.1% in IH + HIT and normoxia + HIT groups, respectively, P = 0.28). In conclusion, these findings suggest that HIT could represent a preventive strategy to limit IH-induced myocardial ischemia-reperfusion damages in OSA patients.
Collapse
Affiliation(s)
- Guillaume Bourdier
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France; Institut National de la Santé et de la Recherche Médicale, U1042, Grenoble, France; and
| | - Patrice Flore
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France; Institut National de la Santé et de la Recherche Médicale, U1042, Grenoble, France; and
| | - Hervé Sanchez
- Institut de Recherche Biomédicale des Armées, Operational Environments, Brétigny/Orge, France
| | - Jean-Louis Pepin
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France; Institut National de la Santé et de la Recherche Médicale, U1042, Grenoble, France; and
| | - Elise Belaidi
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France; Institut National de la Santé et de la Recherche Médicale, U1042, Grenoble, France; and
| | - Claire Arnaud
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France; Institut National de la Santé et de la Recherche Médicale, U1042, Grenoble, France; and
| |
Collapse
|
26
|
Mansukhani MP, Kara T, Caples SM, Somers VK. Chemoreflexes, sleep apnea, and sympathetic dysregulation. Curr Hypertens Rep 2015; 16:476. [PMID: 25097113 DOI: 10.1007/s11906-014-0476-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) and hypertension are closely linked conditions. Disordered breathing events in OSA are characterized by increasing efforts against an occluded airway while asleep, resulting in a marked sympathetic response. This is predominantly due to hypoxemia activating the chemoreflexes, resulting in reflex increases in sympathetic neural outflow. In addition, apnea - and the consequent lack of inhibition of the sympathetic system that occurs with lung inflation during normal breathing - potentiates central sympathetic outflow. Sympathetic activation persists into the daytime, and is thought to contribute to hypertension and other adverse cardiovascular outcomes. This review discusses chemoreflex physiology and sympathetic modulation during normal sleep, as well as the sympathetic dysregulation seen in OSA, its extension into wakefulness, and changes after treatment. Evidence supporting the role of the peripheral chemoreflex in the sympathetic dysregulation seen in OSA, including in the context of comorbid obesity, metabolic syndrome, and systemic hypertension, is reviewed. Finally, alterations in cardiovascular variability and other potential mechanisms that may play a role in the autonomic imbalance in OSA are also discussed.
Collapse
Affiliation(s)
- Meghna P Mansukhani
- Sleep Medicine, Affiliated Communities Medical Center, 101 Willmar Avenue SW, Willmar, MN, USA,
| | | | | | | |
Collapse
|
27
|
Abstract
Obstructive sleep apnea (OSA) is a common disorder associated with cardiovascular disease (CVD). One theory to explain this relationship proposes that OSA can induce systemic inflammation, thereby inducing CVD. This theory is based on the premise that obesity is a pro-inflammatory state, and that physiological derangements during sleep in subjects with OSA further aggravate inflammation. In support of this theory, some clinical studies have shown elevated inflammatory biomarkers in OSA subjects, or improvement in these markers following treatment of OSA. However, the data are inconsistent and often confounded by the effects of comorbid obesity. Animal models of OSA have been developed, which involve exposure of rodents or cells to intermittent hypoxia, a hallmark feature of OSA. Several of these experiments demonstrate that intermittent hypoxia can stimulate inflammatory pathways and lead to cardiovascular or metabolic pathology. In this review, we review relationships between OSA and inflammation, with particular attention to studies published within the last year.
Collapse
Affiliation(s)
- Dileep Unnikrishnan
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Rm 5B.81, Baltimore, MD, 21224, USA
| | | | | |
Collapse
|
28
|
Impact of medications on cognitive function in obstructive sleep apnea syndrome. Sleep Breath 2015; 19:939-45. [PMID: 25566945 DOI: 10.1007/s11325-014-1105-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE Medications can impact cognitive function. Obstructive sleep apnea syndrome (OSAS) is associated with cognitive impairment. There is currently a paucity of data evaluating the impact of medications on sleep architecture and cognition in untreated OSAS. Our objective was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) and medications on cognition by a screening questionnaire called the Mail-In Cognitive Function Screening Instrument (MCFSI). METHODS We conducted a retrospective chart review on consecutive adults (age > 18 years) with OSAS seen in Medical University of South Carolina Sleep Clinic between January 1, 2012 and May 8, 2013, for whom the Mail-In Cognitive Function Screening Instrument (MCFSI) score was available and who were not on continuous positive airway pressure (CPAP). The correlation between different medications, sleep study variables, and MCFSI scores was studied. RESULTS Univariate analysis revealed that many medications had significant correlations with MCFSI scores, including antidepressants (p = 0.05), antipsychotics (p = 0.01), anxiolytics (p = 0.005), statins (p = 0.077) and narcotics (p = 0.006). The mean percentage of rapid eye movement (REM) sleep (p = 0.04) and Epworth Sleepiness Scale (p = 0.01) were also significantly correlated with MCFSI scores. Multivariate analysis revealed that Epworth Sleepiness Scale and use of antipsychotics, narcotics, and anxiolytics correlated with higher MCFSI scores (worse cognition) and conversely that statin use was associated with improved cognition. CONCLUSIONS Medications have a significant impact on cognitive function in OSAS. Thus, medication use should be considered in future studies of cognitive function in patients with OSAS.
Collapse
|
29
|
Lucking EF, O'Halloran KD, Jones JFX. Increased cardiac output contributes to the development of chronic intermittent hypoxia-induced hypertension. Exp Physiol 2014; 99:1312-24. [DOI: 10.1113/expphysiol.2014.080556] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Eric F. Lucking
- UCD School of Medicine and Medical Science; University College Dublin; Dublin 4 Ireland
| | - Ken D. O'Halloran
- Department of Physiology; School of Medicine; University College Cork; Cork Ireland
| | - James F. X. Jones
- UCD School of Medicine and Medical Science; University College Dublin; Dublin 4 Ireland
| |
Collapse
|
30
|
Diogo LN, Monteiro EC. The efficacy of antihypertensive drugs in chronic intermittent hypoxia conditions. Front Physiol 2014; 5:361. [PMID: 25295010 PMCID: PMC4170135 DOI: 10.3389/fphys.2014.00361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/03/2014] [Indexed: 12/22/2022] Open
Abstract
Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CPAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.
Collapse
Affiliation(s)
- Lucilia N Diogo
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisboa, Portugal
| | - Emília C Monteiro
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisboa, Portugal
| |
Collapse
|
31
|
Response to statin therapy in obstructive sleep apnea syndrome: a multicenter randomized controlled trial. Mediators Inflamm 2014; 2014:423120. [PMID: 25221387 PMCID: PMC4158472 DOI: 10.1155/2014/423120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 01/12/2023] Open
Abstract
Rationale. Accumulated evidence implicates sympathetic activation as inducing oxidative stress and systemic inflammation, which in turn lead to hypertension, endothelial dysfunction, and atherosclerosis in obstructive sleep apnea (OSA). Statins through their pleiotropic properties may modify inflammation, lipid profile, and cardiovascular outcomes in OSA. Methods. This multicenter, randomized, double-blind study compared the effects of atorvastatin 40 mg/day versus placebo over 12 weeks on endothelial function (the primary endpoint) measured by peripheral arterial tone (PAT). Secondary endpoints included office blood pressure (BP), early carotid atherosclerosis, arterial stiffness measured by pulse wave velocity (PWV), and metabolic parameters. Results. 51 severe OSA patients were randomized. Key demographics for the study population were age 54 ± 11 years, 21.6% female, and BMI 28.5 ± 4.5 kg/m2. In intention to treat analysis, mean PAT difference between atorvastatin and placebo groups was 0.008 (−0.29; 0.28), P = 0.979. Total and LDL cholesterol significantly improved with atorvastatin. Systolic BP significantly decreased with atorvastatin (mean difference: −6.34 mmHg (−12.68; −0.01), P = 0.050) whereas carotid atherosclerosis and PWV were unchanged compared to the placebo group. Conclusion. In OSA patients, 3 months of atorvastatin neither improved endothelial function nor reduced early signs of atherosclerosis although it lowered blood pressure and improved lipid profile. This trial is registered with NCT00669695.
Collapse
|
32
|
Affiliation(s)
- Tomas Konecny
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | | | | |
Collapse
|