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Irigoyen MC, Fetter C, De Angelis K. Advances on the Experimental Research in Resistant Hypertension. Curr Hypertens Rep 2024:10.1007/s11906-024-01315-2. [PMID: 39023702 DOI: 10.1007/s11906-024-01315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE OF REVIEW Resistant Hypertension (RH) poses a significant public health challenge, contributing to increased mortality, cardiovascular events and organ damage. Both clinical and experimental research are striving for higher standards in a translational manner to integrate new findings and confirm hypotheses. Considering that many are the aspects of RH that are still under investigation, this review aims to shed light on the advances made in experimental research concerning RH. It seeks to underscore the pivotal role of experimental studies in shaping clinical practices and also explore future perspectives. RECENT FINDINGS It is important to emphasize the significance of experimental models, primarily for advancing our understanding: experimental models have greatly contributed to our comprehension of the underlying mechanisms in RH, including factors like sympathetic activation, endothelial dysfunction and structural vessel abnormalities. Secondly, for assessing treatment approaches: animal models have also played a crucial role in evaluating the potential effectiveness of diverse treatment approaches for RH. These encompass both pharmacological options, involving combinations of established drugs or novel pharmaceuticals, and non-pharmacological alternatives, which include surgical procedures like renal denervation, medical devices like baroreceptor stimulators, and lifestyle modifications. The most lacking component in translational research is the fact that there is no well-established animal model that perfectly replicates RH. Consequently, alternative strategies, including the combination of models, must be considered. What remains clear is that the development of animal models closely mimicking RH holds the promise of providing valuable insights into the essential mechanisms and responses necessary to combat or slow the global progression of RH.
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Affiliation(s)
- Maria Claudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), Sao Paulo University Medical School, Sao Paulo, Brazil.
| | - Claudia Fetter
- Laboratory of Clinical Investigation (LIC), Institute of Cardiology of Rio Grande do Sul/ Cardiology University Foundation (IC- FUC), Porto Alegre, Brazil
| | - Kátia De Angelis
- Department of Physiology, Federal University of São Paulo (UNIFESP), Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
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Singh R, Gholipourmalekabadi M, Shafikhani SH. Animal models for type 1 and type 2 diabetes: advantages and limitations. Front Endocrinol (Lausanne) 2024; 15:1359685. [PMID: 38444587 PMCID: PMC10912558 DOI: 10.3389/fendo.2024.1359685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Diabetes mellitus, commonly referred to as diabetes, is a group of metabolic disorders characterized by chronic elevation in blood glucose levels, resulting from inadequate insulin production, defective cellular response to extracellular insulin, and/or impaired glucose metabolism. The two main types that account for most diabetics are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), each with their own pathophysiological features. T1D is an autoimmune condition where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. This leads to lack of insulin, a vital hormone for regulating blood sugar levels and cellular glucose uptake. As a result, those with T1D depend on lifelong insulin therapy to control their blood glucose level. In contrast, T2DM is characterized by insulin resistance, where the body's cells do not respond effectively to insulin, coupled with a relative insulin deficiency. This form of diabetes is often associated with obesity, sedentary lifestyle, and/or genetic factors, and it is managed with lifestyle changes and oral medications. Animal models play a crucial role in diabetes research. However, given the distinct differences between T1DM and T2DM, it is imperative for researchers to employ specific animal models tailored to each condition for a better understanding of the impaired mechanisms underlying each condition, and for assessing the efficacy of new therapeutics. In this review, we discuss the distinct animal models used in type 1 and type 2 diabetes mellitus research and discuss their strengths and limitations.
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Affiliation(s)
- Raj Singh
- Department of Medicine, Division of Hematology, Oncology, & Cell Therapy, Rush University Medical Center, Chicago, IL, United States
| | - Mazaher Gholipourmalekabadi
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sasha H Shafikhani
- Department of Medicine, Division of Hematology, Oncology, & Cell Therapy, Rush University Medical Center, Chicago, IL, United States
- Cancer Center, Rush University Medical Center, Chicago, IL, United States
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Dos Santos F, Li JB, Moreira NJ, Mazor R, Aletti F, Kistler EB. Enteral gabexate mesilate improves volume requirements and autonomic cardiovascular function after experimental trauma/hemorrhagic shock in the absence of blood reperfusion. Am J Transl Res 2022; 14:7391-7402. [PMID: 36398214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/20/2022] [Indexed: 06/16/2023]
Abstract
The standard of care for fluid resuscitation of trauma/hemorrhagic shock (T/HS) is the infusion of blood. However, in many instances, blood product transfusion may not be feasible. Consequently, crystalloid solutions may be utilized as temporizing cost-effective resuscitation fluids. In this study, we explored an alternative therapeutic strategy of enteral protease inhibition adjunctive to intravenous Lactated Ringer's (LR) reperfusion after T/HS. Male Wistar rats underwent midline laparotomy (trauma) and an enteral catheter was inserted orally and positioned post-pyloric for the infusion of vehicle (Golytely®) with or without the serine protease inhibitor gabexate mesilate (GM) (n=8/group). Hemorrhagic shock was induced by blood removal to reduce the mean arterial blood pressure (MAP) to 35-40 mmHg for 90 minutes, before resuscitation with LR. Animals treated with enteral GM required significantly less crystalloid volume to achieve hemodynamic stability and displayed improvements in both blood pressure and autonomic function (via increased baroreflex sensitivity to vasopressors, heightened vascular sympathetic modulation, elevated levels of circulating catecholamines, and increased α1-adrenergic receptor density) compared to untreated (control) shocked animals. Resistance arteries isolated from healthy donor animals and perfused with plasma from untreated T/HS animals revealed impaired vascular response to the α1 adrenergic agonist phenylephrine and decreased reactivity to sodium nitroprusside that was preserved in the GM-treated group. These findings suggest that blockade of serine proteases within the intestinal lumen in non-blood resuscitated experimental T/HS preserves and enhances peripheral sympathetic modulation, improving hemodynamics. Enteral infusion of gabexate mesilate may be a new and promising approach to the management of trauma/hemorrhagic shock.
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Affiliation(s)
- Fernando Dos Santos
- Department of Anesthesiology & Critical Care, University of California San Diego, La Jolla, CA, USA
| | - Joyce B Li
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Nathalia Jd Moreira
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo São Paulo, Brazil
| | - Rafi Mazor
- Department of Anesthesiology & Critical Care, University of California San Diego, La Jolla, CA, USA
| | - Federico Aletti
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo São José dos Campos, Brazil
| | - Erik B Kistler
- Department of Anesthesiology & Critical Care, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System San Diego, CA, USA
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Shi W, Zhang J, Chen D, Chen X, Duan W, Zhang H. Heart Rate Variability and Chronic Kidney Disease in Patients with Type 2 Diabetes. Appl Bionics Biomech 2022; 2022:2475750. [PMID: 35619730 PMCID: PMC9129959 DOI: 10.1155/2022/2475750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
To evaluate whether heart rate variability (HRV) as a measure of cardiac autonomic neuropathy (CAN) is associated with chronic kidney disease (CKD) in Chinese adults with type 2 diabetes mellitus (T2DM) in China. 392 individuals of T2DM were entered in this study, all these subjects undertook the Holter electrocardiogram for 24 hours to get the HRV parameters. Of these T2DM patients, 126 (37.3%) had CKD, and most of the HRV parameters were lower in this group than in those without CKD. Decreased HRV parameters were strongly related with CKD in Spearman's correlation analysis. After adjustments for variables, the logistic regression showed that standard deviation of the averaged normal RR intervals for all 5-minute segments (SDANN) was independently associated with decreased estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2) (OR = 0.988; 95% CI, 0.978-0.998; P = 0.015) and increased urine albumin : creatinine ratio (UACR) ≥ 30 mg/g Cr (OR = 0.992; 95% CI, 0.985-0.998; P = 0.015). A decreased 24-hour time domain HRV parameter, SDANN, was strongly associated with both eGFR and UACR among Chinese T2DM.
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Affiliation(s)
- Wei Shi
- Department of Endocrinology, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine, 430015 Wuhan, Hubei, China
| | - Jing Zhang
- Department of Endocrinology, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine, 430015 Wuhan, Hubei, China
| | - Dan Chen
- Department of Endocrinology, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine, 430015 Wuhan, Hubei, China
| | - Xiaolei Chen
- Department of Endocrinology, Kunming First People's Hospital, Kunming Medical University, 650101 Kunming, Yunnan, China
| | - Wei Duan
- Department of Endocrinology, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine, 430015 Wuhan, Hubei, China
| | - Hongmei Zhang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 430015 Wuhan, Hubei, China
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de Oliveira TL, Lincevicius GS, Shimoura CG, Simões-Sato AY, Garcia ML, T Bergamaschi C, R Campos R. Effects of renal denervation on cardiovascular, metabolic and renal functions in streptozotocin-induced diabetic rats. Life Sci 2021; 278:119534. [PMID: 33933461 DOI: 10.1016/j.lfs.2021.119534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
Diabetes promotes renal sympathetic hyperactivity, autonomic imbalance, and cardiovascular and renal dysfunction. Bilateral renal denervation (BRD) has emerged as a treatment for diabetes; however, the mechanisms that underlie the beneficial effects of BRD are unknown. AIMS The present study evaluated the effects of BRD on autonomic, cardiovascular, metabolic, and renal function in streptozotocin-diabetic rats. MAIN METHODS Wistar rats were separated into three experimental groups: control (CTR), diabetic (DM), and diabetic that underwent BRD (DM BRD). BRD was performed two weeks after STZ-diabetes induction, the experiments were performed four weeks after DM induction. This study evaluated sympathetic vasomotor nerve activity in different territories (renal, lumbar and splanchnic), arterial baroreceptor reflex, metabolic and renal function. KEY FINDINGS BRD significantly reduced glycemia, glycosuria, albuminuria, and SGLT2 gene expression in the kidney in DM rats. Renal sympathetic nerve activity (rSNA) was significantly increased and splanchnic sympathetic nerve activity (sSNA) was significantly decreased in DM rats, without changes in lumbar sympathetic nerve activity (lSNA). BRD was able to normalize sSNA and significantly increase lSNA in DM rats compared to control rats. Additionally, cardiac baroreceptor sensitivity was impaired in DM rats, and BRD significantly improved baroreflex sensitivity. SIGNIFICANCE Our data suggest that renal nerves play an important role in autonomic, cardiovascular, and renal dysfunction in STZ-DM rats. Thus, sympathetic renal hyperactivity should be considered a possible therapeutic target in diabetic patients.
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Affiliation(s)
- Tales Lyra de Oliveira
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Medical School, Universidade Municipal de São Caetano do Sul, São Paulo, Brazil; Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gisele Silvério Lincevicius
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Caroline Gusson Shimoura
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Physiology and Anatomy, University of North Texas Health Science Center, TX, USA
| | - Alex Yuri Simões-Sato
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Michelle Louvaes Garcia
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cássia T Bergamaschi
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ruy R Campos
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
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Guo L, Jiang B, Li D, Xiao X. Nephroprotective Effect of Adropinin Against Streptozotocin-Induced Diabetic Nephropathy in Rats: Inflammatory Mechanism and YAP/TAZ Factor. Drug Des Devel Ther 2021; 15:589-600. [PMID: 33623368 PMCID: PMC7896734 DOI: 10.2147/dddt.s294009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetic Nephropathy remains a major cause of morbidity and mortality in patients suffering from renal dysfunction. This study accessed the nephroprotective role of Adropinin against streptozotocin (STZ) induced diabetic nephropathy in rats and scrutinizes the possible mechanism of action. METHODS STZ (45 mg/kg) dose was used for inducing diabetic nephropathy (DN) and rats were divided into different groups and received the dose-dependent treatment of Adropinin. Blood glucose level, body weight, tissue weight, antioxidant, renal, hepatic parameters, and cytokines were determined. At the end of the experimental study, renal histopathology was performed. RESULTS Adropinin significantly (P<0.001) boosted plasma insulin levels and reduced the blood glucose level. Adropinin considerably increased body weight and reduced kidney weight and kidney hypertrophy. Adropinin significantly (P<0.001) reduced urine outflow, microalbumin, total protein, blood urea nitrogen (BUN), uric acid and increased the creatinine, creatinine clearance. Adropinin significantly (P<0.001) reduced the indole sulfate level in the serum, kidney and reduced in the urine. Adropinin significantly (P<0.001) reduced the total cholesterol, triglyceride, low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL) and increased the level of high-density lipoprotein (HDL). Adropinin significantly (P<0.001) increased the level of antioxidant enzymes such as glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and reduced the level of malonaldehyde (MDA), 8-hydroxy-2' -deoxyguanosine (8-OHdG). Adropinin significantly (P<0.001) reduced the level of interleukin-1β (IL-1β), interleukin-6 (IL-6), transforming growth factor beta (TGF-β) and increased the level of interleukin-10 (IL-10), respectively. Adropinin treatment showed improvement in renal histopathology. CONCLUSION We can say that Adropinin showed the nephroprotective effect against the STZ-induced diabetic nephropathy rats via inflammatory and antioxidant pathway.
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Affiliation(s)
- Ling Guo
- Department of Nephrology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, People’s Republic of China
| | - Bei Jiang
- Department of Nephrology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, People’s Republic of China
| | - Dengren Li
- Department of Nephrology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, People’s Republic of China
| | - Xiaoyan Xiao
- Department of Nephrology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 250012, People’s Republic of China
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Pereira-Moreira R, Muscelli E. Effect of Insulin on Proximal Tubules Handling of Glucose: A Systematic Review. J Diabetes Res 2020; 2020:8492467. [PMID: 32377524 PMCID: PMC7180501 DOI: 10.1155/2020/8492467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023] Open
Abstract
Renal proximal tubules reabsorb glucose from the glomerular filtrate and release it back into the circulation. Modulation of glomerular filtration and renal glucose disposal are some of the insulin actions, but little is known about a possible insulin effect on tubular glucose reabsorption. This review is aimed at synthesizing the current knowledge about insulin action on glucose handling by proximal tubules. Method. A systematic article selection from Medline (PubMed) and Embase between 2008 and 2019. 180 selected articles were clustered into topics (renal insulin handling, proximal tubule glucose transport, renal gluconeogenesis, and renal insulin resistance). Summary of Results. Insulin upregulates its renal uptake and degradation, and there is probably a renal site-specific insulin action and resistance; studies in diabetic animal models suggest that insulin increases renal SGLT2 protein content; in vivo human studies on glucose transport are few, and results of glucose transporter protein and mRNA contents are conflicting in human kidney biopsies; maximum renal glucose reabsorptive capacity is higher in diabetic patients than in healthy subjects; glucose stimulates SGLT1, SGLT2, and GLUT2 in renal cell cultures while insulin raises SGLT2 protein availability and activity and seems to directly inhibit the SGLT1 activity despite it activating this transporter indirectly. Besides, insulin regulates SGLT2 inhibitor bioavailability, inhibits renal gluconeogenesis, and interferes with Na+K+ATPase activity impacting on glucose transport. Conclusion. Available data points to an important insulin participation in renal glucose handling, including tubular glucose transport, but human studies with reproducible and comparable method are still needed.
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Affiliation(s)
- Ricardo Pereira-Moreira
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Zip Code: 13083-887, Brazil
| | - Elza Muscelli
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Zip Code: 13083-887, Brazil
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Effect of renal sympathetic denervation on hepatic glucose metabolism and blood pressure in a rat model of insulin resistance. J Hypertens 2017; 34:2465-2474. [PMID: 27512967 DOI: 10.1097/hjh.0000000000001087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Hypertension and diabetes are associated with impaired glucose metabolism and insulin resistance. Chronic activation of the sympathetic nervous system may contribute to either condition. The purpose of this study was to investigate the effect of renal denervation on glucose kinetics and insulin signal pathways in high-fat diet (HFD)-fed rats. METHODS We examined the effects of renal denervation on glucose kinetics and insulin sensitivity in HFD-fed rats with a hyperinsulinemic-euglycemic clamp technique combined with [3-H] glucose and [U-C]-lactate as a tracer. We also analyzed in vivo the flux through glucose-6-phosphatase and the relative contribution of gluconeogenesis and glycogenolysis in renal denervation rats. In addition, western blotting was used to identify the activities of insulin signaling proteins. RESULTS Renal denervation in HFD-fed rats markedly decreased blood pressure and hepatic glucose production. Hepatic glucose production reduction in renal-denervation-treated rats includes decrease in glycogenolysis by 18.2% for left renal denervation or 31.9% for bilateral renal denervation and decrease in gluconeogenesis by 16.3% for left renal denervation or 42.8% for bilateral renal denervation. These changes were accompanied by decreased hepatic expression of glucose-6-phosphatase and phosphoenolpyruvate carboxykinase. Importantly, renal denervation increased phosphorylation of insulin receptors, insulin receptor substrate-1 and Akt kinase in HFD-fed rats. CONCLUSION These data corroborate the notion that renal denervation potentiates hepatic insulin sensitivity.
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Liu Q, Han L, Chang F, Chen G, Li X, Xia L. The relationship between the autonomic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension. Clin Exp Hypertens 2017; 40:136-140. [PMID: 28786697 DOI: 10.1080/10641963.2017.1346110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Qunwei Liu
- Department of Cardiology, Civil Aviation General Hospital, Beijing, PR China
| | - Limin Han
- Department of Cardiology, Civil Aviation General Hospital, Beijing, PR China
| | - Feng Chang
- Department of Cardiology, Civil Aviation General Hospital, Beijing, PR China
| | - Guoyan Chen
- Department of Cardiology, Civil Aviation General Hospital, Beijing, PR China
| | - Xinrui Li
- Department of Cardiology, Civil Aviation General Hospital, Beijing, PR China
| | - Lijiao Xia
- Clinical laboratory, Civil Aviation General Hospital, Beijing, PR China
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Wei Y, Xu J, Zhou G, Chen S, Ouyang P, Liu S. Renal Denervation Suppresses the Inducibility of Atrial Fibrillation in a Rabbit Model for Atrial Fibrosis. PLoS One 2016; 11:e0160634. [PMID: 27529427 PMCID: PMC4986963 DOI: 10.1371/journal.pone.0160634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/23/2016] [Indexed: 11/18/2022] Open
Abstract
Renal denervation (RD) was reported to reduce the susceptibility of atrial fibrillation (AF), but the underlying mechanism has not been well understood. This study was performed to investigate the effect of RD on the inducibility of AF in a rabbit model for atrial fibrosis and to explore the potential mechanisms. Thirty-five rabbits were randomly assigned into sham-operated group (n = 12), abdominal aortic constriction (AAC) group (n = 12) and AAC with RD (AAC-RD) group (n = 11). The incidence of AF induced by burst pacing in atriums was determined. Blood was collected to measure the levels of rennin, angiotensin II and aldosterone. Atrial samples were preserved to evaluate protein and gene expression of collagen, connective tissue growth factor (CTGF) and transforming growth factor-β1 (TGF-β1). Our data suggested cardiac structure remodeling and atrial fibrosis were successfully induced by AAC. Compared with the AAC group, the AAC-RD rabbits had smaller ascending aortic diameter and left ventricular end-systolic diameter. For burst pacing at the left atrium (LA), AF was induced in two of the 12 rabbits in the sham-operated group, 10 of the 12 rabbits in the AAC group, and 2 of the 11 rabbits in the AAC-RD group, with great difference among the three groups (P = 0.001). The percentage of LA burst stimulations with induced AF achieved 47.2% in the AAC group, which was higher than those in both the AAC-RD (12.1%) and the Sham-operated (5.6%) groups. Significantly increasing intercellular space in the AAC group (P<0.001) compared with the sham-operated rabbits. RD clearly decreased the volume fraction of collagen in LA and right atrium compared with that of the AAC group (P< 0.01). AAC-induced elevation of collagen I, CTGF and TGF-β1 was suppressed by RD. In conclusion, RD suppressed the inducibility of AF in a rabbit model for pressure associated atrial fibrosis, potentially by modulating renin-angiotensin-aldosterone system and decreasing pro-fibrotic factors.
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Affiliation(s)
- Yong Wei
- Department of cardiology, Shanghai Songjiang Central Hospital, Shanghai, 201600, China
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Juan Xu
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Genqing Zhou
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Songwen Chen
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
| | - Ping Ouyang
- Department of cardiology, Shanghai Songjiang Central Hospital, Shanghai, 201600, China
| | - Shaowen Liu
- Department of cardiology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200800, China
- * E-mail:
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11
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Skrzypecki J, Ufnal M. Drug resistant hypertension – no simple way out. Kidney Blood Press Res 2016; 40:66-76. [PMID: 25791632 DOI: 10.1159/000368483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/19/2022] Open
Abstract
Hypertension poses growing challenge for health policy-makers and doctors worldwide. Recently published results of Symplicity-III trial (HTN-3), the first blinded, randomized, multicenter study on the efficacy of renal denervation for the treatment of resistant hypertension did not show a significant reduction of BP in patients with resistant hypertension 6 months after renal-artery denervation, as compared with controls. In this paper we review clinical and experimental studies on renal denervation. In order to identify causes of inconsistent results in renal denervation studies we look at basic science support for renal denervation and at designs of clinical trials.
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Abstract
Experimental renal sympathetic denervation is a well-established technique. Classically, renal sympathetic denervation is achieved by dorsal rhizotomy. While more recently, direct renal sympathetic denervation is typically applied by stripping all visible renal nerve bundles followed by painting with a solution of 10 % phenol in ethanol to remove the remaining nerves. In clinical settings, a reliable marker of renal sympathetic denervation or renal sympathetic overactivity has not been established. However, in experimental models, successful renal sympathetic denervation is validated by a decrease in renal norepinephrine content levels. This facilitates the assessment of incomplete denervation by technical failure and reinnervation for long-term experimental models. In this chapter, we introduce comprehensive methods for direct renal sympathetic denervation and measurement of renal norepinephrine content levels.
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Affiliation(s)
- Masahiro Eriguchi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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13
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Peleli M, Al-Mashhadi A, Yang T, Larsson E, Wåhlin N, Jensen BL, G Persson AE, Carlström M. Renal denervation attenuates NADPH oxidase-mediated oxidative stress and hypertension in rats with hydronephrosis. Am J Physiol Renal Physiol 2015; 310:F43-56. [PMID: 26538440 DOI: 10.1152/ajprenal.00345.2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/28/2015] [Indexed: 12/31/2022] Open
Abstract
Hydronephrosis is associated with the development of salt-sensitive hypertension. Studies have suggested that increased sympathetic nerve activity and oxidative stress play important roles in hypertension and the modulation of salt sensitivity. The present study primarily aimed to examine the role of renal sympathetic nerve activity in the development of hypertension in rats with hydronephrosis. In addition, we aimed to investigate if NADPH oxidase (NOX) function could be affected by renal denervation. Partial unilateral ureteral obstruction (PUUO) was created in 3-wk-old rats to induce hydronephrosis. Sham surgery or renal denervation was performed at the same time. Blood pressure was measured during normal, high-, and low-salt diets. The renal excretion pattern, NOX activity, and expression as well as components of the renin-angiotensin-aldosterone system were characterized after treatment with the normal salt diet. On the normal salt diet, rats in the PUUO group had elevated blood pressure compared with control rats (115 ± 3 vs. 87 ± 1 mmHg, P < 0.05) and displayed increased urine production and lower urine osmolality. The blood pressure change in response to salt loading (salt sensitivity) was more pronounced in the PUUO group compared with the control group (15 ± 2 vs. 5 ± 1 mmHg, P < 0.05). Renal denervation in PUUO rats attenuated both hypertension (97 ± 3 mmHg) and salt sensitivity (5 ± 1 mmHg, P < 0.05) and normalized the renal excretion pattern, whereas the degree of renal fibrosis and inflammation was not changed. NOX activity and expression as well as renin and ANG II type 1A receptor expression were increased in the renal cortex from PUUO rats and normalized by denervation. Plasma Na(+) and K(+) levels were elevated in PUUO rats and normalized after renal denervation. Finally, denervation in PUUO rats was also associated with reduced NOX expression, superoxide production, and fibrosis in the heart. In conclusion, renal denervation attenuates hypertension and restores the renal excretion pattern, which is associated with reduced renal NOX and components of the renin-angiotensin-aldosterone system. This study emphasizes a link between renal nerves, the development of hypertension, and modulation of NOX function.
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Affiliation(s)
- Maria Peleli
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ammar Al-Mashhadi
- Division of Pediatric Surgery, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Ting Yang
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Larsson
- Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Nils Wåhlin
- Department of Pediatric Surgery, Astrid Lindgren Hospital, Karolinska Institutet, Stockholm, Sweden; and
| | - Boye L Jensen
- Department of Physiology and Pharmacology, University of Southern Denmark, Odense, Denmark
| | - A Erik G Persson
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Mattias Carlström
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden;
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Thaung HPA, Yao Y, Bussey CT, Hughes G, Jones PP, Bahn A, Sammut IA, Lamberts RR. Chronic bilateral renal denervation reduces cardiac hypertrophic remodelling but not β-adrenergic responsiveness in hypertensive type 1 diabetic rats. Exp Physiol 2015; 100:628-39. [DOI: 10.1113/ep085021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/13/2015] [Indexed: 11/08/2022]
Affiliation(s)
- H. P. Aye Thaung
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Yimin Yao
- Department of Pharmacology and Toxicology, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Carol T. Bussey
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Gillian Hughes
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Peter P. Jones
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Andrew Bahn
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Ivan A. Sammut
- Department of Pharmacology and Toxicology, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Regis R. Lamberts
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
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15
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Ding X, Xu X, Yan Y, Song X, Liu S, Wang G, Su D, Jing Q, Qin Y. Effects of renal sympathetic denervation and angiotensin-converting enzyme inhibitor on left ventricular hypertrophy. Herz 2014; 40:695-701. [DOI: 10.1007/s00059-014-4110-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/11/2014] [Accepted: 04/18/2014] [Indexed: 01/19/2023]
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16
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Ariyanon W, Mao H, Adýbelli Z, Romano S, Rodighiero M, Reimers B, La Vecchia L, Ronco C. Renal denervation: intractable hypertension and beyond. Cardiorenal Med 2014; 4:22-33. [PMID: 24847331 DOI: 10.1159/000357597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/22/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypertension continues to be a major burden of public health concern despite the recent advances and proven benefit of pharmacological therapy. A certain subset of patients has hypertension resistant to maximal medical therapy and appropriate lifestyle measures. A novel catheter-based technique for renal denervation (RDN) as a new therapeutic avenue has great promise for the treatment of refractory hypertension. SUMMARY This review included the physiology of the renal sympathetic nervous system and the renal nerve anatomy. Furthermore, the RDN procedure, technology systems, and RDN clinical trials as well as findings besides antihypertensive effects were discussed. Findings on safety and efficacy seem to suggest that renal sympathetic denervation could be of therapeutic benefit in refractory hypertensive patients. Despite the fast pace of development in RDN therapies, only initial and very limited clinical data are available. Large gaps in knowledge concerning the long-term effects and consequences of RDN still exist, and solid, randomized data are warranted.
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Affiliation(s)
- Wassawon Ariyanon
- Department of Nephrology, San Bortolo Hospital, Italy ; International Renal Research Institute Vicenza (IRRIV), Italy ; Cardio-Metabolic Center, BNH Hospital, Bangkok, Thailand
| | - Huijuan Mao
- Department of Nephrology, San Bortolo Hospital, Italy ; International Renal Research Institute Vicenza (IRRIV), Italy ; Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zelal Adýbelli
- Department of Nephrology, San Bortolo Hospital, Italy ; International Renal Research Institute Vicenza (IRRIV), Italy
| | - Silvia Romano
- Department of Cardiology, City Hospital, Milan, Italy
| | - Mariapia Rodighiero
- Department of Nephrology, San Bortolo Hospital, Italy ; International Renal Research Institute Vicenza (IRRIV), Italy
| | | | | | - Claudio Ronco
- Department of Nephrology, San Bortolo Hospital, Italy ; International Renal Research Institute Vicenza (IRRIV), Italy
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Batulevicius D, Frese T, Peschke E, Pauza DH, Batuleviciene V. Remodelling of the intracardiac ganglia in diabetic Goto-Kakizaki rats: an anatomical study. Cardiovasc Diabetol 2013; 12:85. [PMID: 23758627 PMCID: PMC3688305 DOI: 10.1186/1475-2840-12-85] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/31/2013] [Indexed: 12/20/2022] Open
Abstract
Background Although cardiac autonomic neuropathy is one of major complications of diabetes mellitus (DM), anatomical data on cardiac innervation of diabetic animal models is scant and controversial. We performed this study to check whether long-term diabetic state impacts the anatomy of intracardiac ganglia in Goto-Kakizaki (GK) rats, a genetic model of type 2 DM. Methods Twelve GK rats (276 ± 17 days of age; mean ± standard error) and 13 metabolically healthy Wistar rats (262 ± 5 days of age) as controls were used for this study. Blood glucose was determined using test strips, plasma insulin by radioimmunoassay. Intrinsic ganglia and nerves were visualized by acetylcholinesterase histochemistry on whole hearts. Ganglion area was measured, and the neuronal number was assessed according to ganglion area. Results The GK rats had significantly elevated blood glucose level compared to controls (11.0 ± 0.6 vs. 5.9 ± 0.1 mmol/l, p < 0.001), but concentration of plasma insulin did not differ significantly between the two groups (84.0 ± 9.8 vs. 67.4 ± 10.9 pmol/l, p = 0.17). The GK rats contained significantly fewer intracardiac ganglia, decreased total area of intracardiac ganglia (1.4 ± 0.1 vs. 2.2 ± 0.1 mm2, p < 0.001) and smaller somata of ganglionic neurons. Mean total number of intracardiac neurons in GK rats was 1461 ± 62, while this number in control rats was higher by 39% and reached 2395 ± 110 (p < 0.001). Conclusions Results of our study demonstrate the decreased number of intracardiac neurons in GK rats compared to metabolically healthy Wistar rats of similar age. It is likely that the observed structural remodelling of intracardiac ganglia in GK rats is caused by a long-term diabetic state.
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Thackeray JT, Radziuk J, Harper ME, Suuronen EJ, Ascah KJ, Beanlands RS, Dasilva JN. Sympathetic nervous dysregulation in the absence of systolic left ventricular dysfunction in a rat model of insulin resistance with hyperglycemia. Cardiovasc Diabetol 2011; 10:75. [PMID: 21831292 PMCID: PMC3170183 DOI: 10.1186/1475-2840-10-75] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/10/2011] [Indexed: 12/19/2022] Open
Abstract
Background Diabetes mellitus is strongly associated with cardiovascular dysfunction, derived in part from impairment of sympathetic nervous system signaling. Glucose, insulin, and non-esterified fatty acids are potent stimulants of sympathetic activity and norepinephrine (NE) release. We hypothesized that sustained hyperglycemia in the high fat diet-fed streptozotocin (STZ) rat model of sustained hyperglycemia with insulin resistance would exhibit progressive sympathetic nervous dysfunction in parallel with deteriorating myocardial systolic and/or diastolic function. Methods Cardiac sympathetic nervous integrity was investigated in vivo via biodistribution of the positron emission tomography radiotracer and NE analogue [11C]meta-hydroxyephedrine ([11C]HED). Cardiac systolic and diastolic function was evaluated by echocardiography. Plasma and cardiac NE levels and NE reuptake transporter (NET) expression were evaluated as correlative measurements. Results The animal model displays insulin resistance, sustained hyperglycemia, and progressive hypoinsulinemia. After 8 weeks of persistent hyperglycemia, there was a significant 13-25% reduction in [11C]HED retention in myocardium of STZ-treated hyperglycemic but not euglycemic rats as compared to controls. There was a parallel 17% reduction in immunoblot density for NE reuptake transporter, a 1.2 fold and 2.5 fold elevation of cardiac and plasma NE respectively, and no change in sympathetic nerve density. No change in ejection fraction or fractional area change was detected by echocardiography. Reduced heart rate, prolonged mitral valve deceleration time, and elevated transmitral early to atrial flow velocity ratio measured by pulse-wave Doppler in hyperglycemic rats suggest diastolic impairment of the left ventricle. Conclusions Taken together, these data suggest that sustained hyperglycemia is associated with elevated myocardial NE content and dysregulation of sympathetic nervous system signaling in the absence of systolic impairment.
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Affiliation(s)
- James T Thackeray
- Molecular Function & Imaging Program, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7, Canada
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Dias LD, Casali KR, Leguisamo NM, Azambuja F, Souza MS, Okamoto M, Machado UF, Irigoyen MC, Schaan BD. Erratum to: Renal denervation in an animal model of diabetes and hypertension: Impact on the autonomic nervous system and nephropathy. Cardiovasc Diabetol 2011. [PMCID: PMC3123179 DOI: 10.1186/1475-2840-10-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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