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Depressed HCN4 function in the type 2 diabetic sinoatrial node. Mol Cell Biochem 2022. [DOI: 10.1007/s11010-022-04635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sciacqua A, Succurro E, Armentaro G, Miceli S, Pastori D, Rengo G, Sesti G. Pharmacological treatment of type 2 diabetes in elderly patients with heart failure: randomized trials and beyond. Heart Fail Rev 2021; 28:667-681. [PMID: 34859336 DOI: 10.1007/s10741-021-10182-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) and type 2 diabetes mellitus (T2DM) represent two important public health problems, and despite improvements in the management of both diseases, they are responsible for high rates of hospitalizations and mortality. T2DM accelerates physiological cardiac aging through hyperglycemia and hyperinsulinemia. Thus, HF and T2DM are chronic diseases widely represented in elderly people who often are affected by numerous comorbidities with important functional limitations making it difficult to apply the current guidelines. Several antidiabetic drugs should be used with caution in elderly individuals with T2DM. For instance, sulfonylureas should be avoided due to the risk of hypoglycemia associated with its use. Insulin should be used with caution because it is associated with higher risk of hypoglycemia, and may determine fluid retention which can lead to worsening of HF. Thiazolindinediones should be avoided due to the increased risk of fluid retention and HF. Biguanides may lead to a slightly increased risk of lactic acidosis in particular in elderly individuals with impaired renal function. Dipeptidyl peptidase 4 (DPP-4) inhibitors are safe having few side effects, minimal risk of hypoglycemia, and a neutral effect on cardiovascular (CV) outcome, even if it has been reported that saxagliptin treatment is associated with increased risk of hospitalizations for HF (hHF). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a CV protection without a significant reduction in hHF. On the other hand, sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown a significant improvement in CV outcome, with a strong reduction of hHF and a positive impact on renal damage progression. However, it is necessary to consider the possible some side effects related to their use in elderly individuals including hypotension, bone fractures, and ketoacidosis.It is important to remark that elderly patients, in particular the very elderly, are not sufficiently represented in the trials; thus, the management and treatment of elderly diabetic patients with HF should be mainly based on the integration of scientific evidence with clinical judgment and patients' condition, with respect to the dignity and quality of life.
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Affiliation(s)
- Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy.
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Istituti Clinici Scientifici (ICS) Maugeri SPA, Società Benefit, IRCCS, Pavia, Italy
- Istituto Scientifico di Telese Terme, Telese, Terme, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University Rome-Sapienza, Rome, Italy
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Erdogan BR, Michel MC, Arioglu-Inan E. Expression and Signaling of β-Adrenoceptor Subtypes in the Diabetic Heart. Cells 2020; 9:cells9122548. [PMID: 33256212 PMCID: PMC7759850 DOI: 10.3390/cells9122548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
Diabetes is a chronic, endocrine disorder that effects millions of people worldwide. Cardiovascular complications are the major cause of diabetes-related morbidity and mortality. Cardiac β1- and β2-adrenoceptor (AR) stimulation mediates positive inotropy and chronotropy, whereas β3-AR mediates negative inotropic effect. Changes in β-AR responsiveness are thought to be an important factor that contributes to the diabetic cardiac dysfunction. Diabetes related changes in β-AR expression, signaling, and β-AR mediated cardiac function have been studied by several investigators for many years. In the present review, we have screened PubMed database to obtain relevant articles on this topic. Our search has ended up with wide range of different findings about the effect of diabetes on β-AR mediated changes both in molecular and functional level. Considering these inconsistent findings, the effect of diabetes on cardiac β-AR still remains to be clarified.
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Affiliation(s)
- Betul R. Erdogan
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, 06560 Ankara, Turkey;
- Department of Pharmacology, Faculty of Pharmacy, Izmir Katip Celebi University, 35620 Izmir, Turkey
| | - Martin C. Michel
- Department of Pharmacology, Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Ebru Arioglu-Inan
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, 06560 Ankara, Turkey;
- Correspondence:
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Christensen RH, von Scholten BJ, Lehrskov LL, Rossing P, Jørgensen PG. Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes? Ther Adv Endocrinol Metab 2020; 11:2042018820928824. [PMID: 32518616 PMCID: PMC7252363 DOI: 10.1177/2042018820928824] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/03/2020] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with an increased risk of cardiovascular disease and heart failure, which highlights the need for improved understanding of factors contributing to the pathophysiology of these complications as they are the leading cause of mortality in T2D. Patients with T2D have high levels of epicardial adipose tissue (EAT). EAT is known to secrete inflammatory factors, lipid metabolites, and has been proposed to apply mechanical stress on the cardiac muscle that may accelerate atherosclerosis, cardiac remodeling, and heart failure. High levels of EAT in patients with T2D have been associated with atherosclerosis, diastolic dysfunction, and incident cardiovascular events, and this fat depot has been suggested as an important link coupling diabetes, obesity, and cardiovascular disease. Despite this, the predictive potential of EAT in general, and in patients with diabetes, is yet to be established, and, up until now, the clinical relevance of EAT is therefore limited. Should this link be established, importantly, studies show that this fat depot can be modified both by pharmacological and lifestyle interventions. In this review, we first introduce the role of adipose tissue in T2D and present mechanisms involved in the pathophysiology of EAT and pericardial adipose tissue (PAT) in general, and in patients with T2D. Next, we summarize the evidence that these fat depots are elevated in patients with T2D, and discuss whether they might drive the high cardiometabolic risk in patients with T2D. Finally, we discuss the clinical potential of cardiac adipose tissues, address means to target this depot, and briefly touch upon underlying mechanisms and future research questions.
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Affiliation(s)
| | | | - Louise Lang Lehrskov
- Center for Inflammation and Metabolism/Center for Physical Activity Research, Rigshospitalet, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cook RF, Bussey CT, Fomison‐Nurse IC, Hughes G, Bahn A, Cragg PA, Lamberts RR. β
2
‐Adrenoceptors indirectly support impaired β
1
‐adrenoceptor responsiveness in the isolated type 2 diabetic rat heart. Exp Physiol 2019; 104:808-818. [DOI: 10.1113/ep087437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/18/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Rosalind F. Cook
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
| | - Carol T. Bussey
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
| | - Ingrid C. Fomison‐Nurse
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
| | - Gillian Hughes
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
| | - Andrew Bahn
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
| | - Patricia A. Cragg
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
| | - Regis R. Lamberts
- Department of Physiology – HeartOtagoSchool of Biomedical SciencesUniversity of Otago Dunedin New Zealand
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Bussey CT, Thaung HPA, Hughes G, Bahn A, Lamberts RR. Cardiac β-adrenergic responsiveness of obese Zucker rats: The role of AMPK. Exp Physiol 2018; 103:1067-1075. [PMID: 29873129 DOI: 10.1113/ep087054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/30/2018] [Indexed: 01/30/2023]
Abstract
NEW FINDINGS What is the central question of the study? Is the reduced signalling of AMP-activated protein kinase (AMPK), a key regulator of energy homeostasis in the heart, responsible for the reduced β-adrenergic responsiveness of the heart in obesity? What is the main finding and its importance? Inhibition of AMPK in isolated hearts prevented the reduced cardiac β-adrenergic responsiveness of obese rats, which was accompanied by reduced phosphorylation of AMPK, a proxy of AMPK activity. This suggests a direct functional link between β-adrenergic responsiveness and AMPK signalling in the heart, and it suggests that AMPK might be an important target to restore the β-adrenergic responsiveness in the heart in obesity. ABSTRACT The obesity epidemic impacts heavily on cardiovascular health, in part owing to changes in cardiac metabolism. AMP-activated protein kinase (AMPK) is a key regulator of energy homeostasis in the heart and is regulated by β-adrenoceptors (β-ARs) in normal conditions. In obesity, chronic sympathetic overactivation leads to impaired cardiac β-AR responsiveness, although it is unclear whether AMPK signalling, downstream of β-ARs, contributes to this dysfunction. Therefore, we aimed to determine whether reduced AMPK signalling is responsible for the reduced β-AR responsiveness in obesity. In isolated hearts of lean and obese Zucker rats, we tested β-AR responsiveness to the β1 -AR agonist isoprenaline (ISO, 1 × 10-10 to 5 × 10-8 m) in the absence and presence of the AMPK inhibitor, compound C (CC, 10 μm). The β1 -AR expression and AMPK phosphorylation were assessed by Western blot. β-Adrenergic responsiveness was reduced in the hearts of obese rats (logEC50 of ISO-developed pressure dose-response curves: lean -8.53 ± 0.13 × 10x m versus obese -8.35 ± 0.10 × 10x m ; P < 0.05 lean versus obese, n = 6 per group). This difference was not apparent after AMPK inhibition (logEC50 of ISO-developed pressure curves: lean CC -8.19 ± 0.12 × 10x m versus obese CC 8.17 ± 0.13 × 10x m, P < 0.05, n = 6 per group). β1 -Adrenergic receptor expression and AMPK phosphorylation were reduced in hearts of obese rats (AMPK at Thr172 : lean 1.73 ± 0.17 a.u. versus lean CC 0.81 ± 0.13 a.u., and obese 1.18 ± 0.09 a.u. versus obese CC 0.81 ± 0.16 a.u., P < 0.05, n = 6 per group). Thus, a direct functional link between β-adrenergic responsiveness and AMPK signalling in the heart exists, and AMPK might be an important target to restore the reduced cardiac β-adrenergic responsiveness in obesity.
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Affiliation(s)
- Carol T Bussey
- Department of Physiology - HeartOtago, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - H P Aye Thaung
- Department of Physiology - HeartOtago, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Gillian Hughes
- Department of Physiology - HeartOtago, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Andrew Bahn
- Department of Physiology - HeartOtago, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Regis R Lamberts
- Department of Physiology - HeartOtago, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Bussey CT, Lamberts RR. Effect of type 2 diabetes, surgical incision, and volatile anesthesia on hemodynamics in the rat. Physiol Rep 2018; 5:5/14/e13352. [PMID: 28716819 PMCID: PMC5532486 DOI: 10.14814/phy2.13352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/17/2017] [Indexed: 01/05/2023] Open
Abstract
Diabetic patients have increased cardiac complications during surgery, possibly due to impaired autonomic regulation. Anesthesia lowers blood pressure and heart rate (HR), whereas surgical intervention has opposing effects. The interaction of anesthesia and surgical intervention on hemodynamics in diabetes is unknown, despite being a potential perioperative risk factor. We aimed to determine the effect of diabetes on the integrative interaction between hemodynamics, anesthesia, and surgical incision. Zucker type 2 diabetic rats (DM) and their nondiabetic littermates (ND) were implanted with an intravenous port for drug delivery, and a radiotelemeter to measure mean arterial blood pressure (MAP) and derive HR (total n = 50). Hemodynamic pharmacological responses were assessed under conscious, isoflurane anesthesia (~2-2.5%), and anesthesia-surgical conditions; the latter performed as a laparotomy. MAP was not different between groups under conscious conditions (ND 120 ± 6 vs. DM 131 ± 4 mmHg, P > 0.05). Anesthesia reduced MAP, but not differently in DM (ND -30 ± 6 vs. DM -38 ± 4 ΔmmHg, P > 0.05). Despite adequate anesthesia, surgical incision increased MAP, which tended to be less in DM (ND +21 ± 4 vs. DM +13 ± 2 ΔmmHg, P = 0.052). Anesthesia disrupted central baroreflex HR responses to sympathetic activation (sodium nitroprusside 10 μg·kg-1, ND conscious 83 ± 13 vs. anesthetized 16 ± 5 Δbpm; P < 0.05) or to sympathetic withdrawal (phenylephrine 10 μg·kg-1, ND conscious -168 ± 37 vs. anesthetized -20 ± 6 Δbpm; P < 0.05) with no additional changes observed after surgical incision or during diabetes. During perioperative conditions, type 2 diabetes did not impact on short-term hemodynamic regulation. Anesthesia had the largest hemodynamic impact, whereas surgical effects were limited to modulation of baseline blood pressure.
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Affiliation(s)
- Carol T Bussey
- Department of Physiology - HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Regis R Lamberts
- Department of Physiology - HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Heil LBB, Silva PL, Pelosi P, Rocco PRM. Immunomodulatory effects of anesthetics in obese patients. World J Crit Care Med 2017; 6:140-152. [PMID: 28828299 PMCID: PMC5547428 DOI: 10.5492/wjccm.v6.i3.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/27/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
Abstract
Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells (such as monocytes, neutrophils, and specific tissue macrophages) with release of pro- or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.
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Cook RF, Bussey CT, Mellor KM, Cragg PA, Lamberts RR. β1-Adrenoceptor, but not β2-adrenoceptor, subtype regulates heart rate in type 2 diabetic ratsin vivo. Exp Physiol 2017; 102:911-923. [DOI: 10.1113/ep086293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/16/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Rosalind F. Cook
- Department of Physiology, Otago School of Medical Sciences, HeartOtago; University of Otago; Dunedin New Zealand
| | - Carol T. Bussey
- Department of Physiology, Otago School of Medical Sciences, HeartOtago; University of Otago; Dunedin New Zealand
| | - Kimberley M. Mellor
- Department of Physiology, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Patricia A. Cragg
- Department of Physiology, Otago School of Medical Sciences, HeartOtago; University of Otago; Dunedin New Zealand
| | - Regis R. Lamberts
- Department of Physiology, Otago School of Medical Sciences, HeartOtago; University of Otago; Dunedin New Zealand
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Abstract
Critical illness is a major cause of morbidity and mortality around the world. While obesity is often detrimental in the context of trauma, it is paradoxically associated with improved outcomes in some septic patients. The reasons for these disparate outcomes are not well understood. A number of animal models have been used to study the obese response to various forms of critical illness. Just as there have been many animal models that have attempted to mimic clinical conditions, there are many clinical scenarios that can occur in the highly heterogeneous critically ill patient population that occupies hospitals and intensive care units. This poses a formidable challenge for clinicians and researchers attempting to understand the mechanisms of disease and develop appropriate therapies and treatment algorithms for specific subsets of patients, including the obese. The development of new, and the modification of existing animal models, is important in order to bring effective treatments to a wide range of patients. Not only do experimental variables need to be matched as closely as possible to clinical scenarios, but animal models with pre-existing comorbid conditions need to be studied. This review briefly summarizes animal models of hemorrhage, blunt trauma, traumatic brain injury, and sepsis. It also discusses what has been learned through the use of obese models to study the pathophysiology of critical illness in light of what has been demonstrated in the clinical literature.
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Nishijima Y, Akamatsu Y, Yang SY, Lee CC, Baran U, Song S, Wang RK, Tominaga T, Liu J. Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice. Stroke 2016; 47:3014-3021. [PMID: 27834741 DOI: 10.1161/strokeaha.116.014882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/03/2016] [Accepted: 09/14/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status, it is unclear whether and to what extent type 2 diabetes mellitus affects cerebral collateral flow regulation during hypoperfusion. METHODS We examined the spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal middle cerebral artery and anterior cerebral artery branches over 2 weeks after unilateral common carotid artery occlusion (CCAO) using optical coherent tomography in db/+ and db/db mice. We also assessed the temporal adaptation of the circle of Willis after CCAO by measuring circle of Willis vessel diameters. RESULTS After unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared with db/+ mice, which coincided with a reduced dilation of distal anterior cerebral artery branches, leading to reduced flow not only in pial vessels but also in penetrating arterioles bordering the distal middle cerebral artery and anterior cerebral artery. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the circle of Willis, in addition to a delayed post-CCAO adaptive response by 1 to 2 weeks, compared with db/+ mice. CONCLUSIONS Type 2 diabetes mellitus is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or transient ischemic attack.
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Affiliation(s)
- Yasuo Nishijima
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Yosuke Akamatsu
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Shih Yen Yang
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Chih Cheng Lee
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Utku Baran
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Shaozhen Song
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Ruikang K Wang
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Teiji Tominaga
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.)
| | - Jialing Liu
- Department of Neurological Surgery, University of California at San Francisco (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); San Francisco Veterans Affairs Medical Center, CA (Y.N., Y.A., S.Y.Y., C.C.L., J.L.); Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan (Y.N., Y.A., T.T.); and Departments of Bioengineering & Ophthalmology, University of Washington, Seattle (U.B., S.S., R.K.W.).
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Boly CA, Eringa EC, Bouwman RA, van den Akker RFP, de Man FS, Schalij I, Loer SA, Boer C, van den Brom CE. The effect of perioperative insulin treatment on cardiodepression in mild adiposity in mice. Cardiovasc Diabetol 2016; 15:135. [PMID: 27651131 PMCID: PMC5029087 DOI: 10.1186/s12933-016-0453-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/13/2016] [Indexed: 02/02/2023] Open
Abstract
Background While most studies focus on cardiovascular morbidity following anesthesia and surgery in excessive obesity, it is unknown whether these intraoperative cardiovascular alterations also occur in milder forms of adiposity without type 2 diabetes and if insulin is a possible treatment to improve intraoperative myocardial performance. In this experimental study we investigated whether mild adiposity without metabolic alterations is already associated with cardiometabolic dysfunction during anesthesia, mechanical ventilation and surgery and whether these myocardial alterations can be neutralized by intraoperative insulin treatment. Methods Mice were fed a western (WD) or control diet (CD) for 4 weeks. After metabolic profiling, mice underwent general anesthesia, mechanical ventilation and surgery. Cardiac function was determined with echocardiography and left-ventricular pressure–volume analysis. Myocardial perfusion was determined with contrast-enhanced echocardiography. WD-fed mice were subsequently treated with insulin by hyperinsulinemic euglycemic clamping followed by the same measurements of cardiac function and perfusion. Results Western-type diet feeding led to a 13 % increase in bodyweight, (p < 0.0001) and increased adipose tissue mass, without metabolic alterations. Despite this mild phenotype, WD-fed mice had decreased systolic and diastolic function (end-systolic elastance was 2.0 ± 0.5 versus 4.1 ± 2.4 mmHg/μL, p = 0.01 and diastolic beta was 0.07 ± 0.03 versus 0.04 ± 0.01 mmHg/μL, p = 0.02) compared to CD-fed mice. Ventriculo-arterial coupling and myocardial perfusion were decreased by 48 % (p = 0.003) and 43 % (p = 0.03) respectively. Insulin treatment in WD-fed mice improved echo-derived systolic function (fractional shortening 42 ± 5 % to 46 ± 3, p = 0.05), likely due to decreased afterload, but there was no effect on load-independent measures of systolic function or myocardial perfusion. However, there was a trend towards improved diastolic function after insulin treatment (43 % improvement, p = 0.05) in WD-fed mice. Conclusions Mild adiposity without metabolic alterations already affected cardiac function and perfusion during anesthesia, mechanical ventilation and surgery in mice. Intraoperative insulin may be beneficial to reduce afterload and enhance intraoperative ventricular relaxation, but not to improve ventricular contractility or myocardial perfusion.
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Affiliation(s)
- Chantal A Boly
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Etto C Eringa
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Rob F P van den Akker
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.,Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingrid Schalij
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.,Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Stephan A Loer
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Christa Boer
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Charissa E van den Brom
- Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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Emans TW, Janssen BJ, Pinkham MI, Ow CPC, Evans RG, Joles JA, Malpas SC, Krediet CTP, Koeners MP. Exogenous and endogenous angiotensin-II decrease renal cortical oxygen tension in conscious rats by limiting renal blood flow. J Physiol 2016; 594:6287-6300. [PMID: 27426098 PMCID: PMC5088249 DOI: 10.1113/jp270731] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023] Open
Abstract
KEY POINTS Our understanding of the mechanisms underlying the role of hypoxia in the initiation and progression of renal disease remains rudimentary. We have developed a method that allows wireless measurement of renal tissue oxygen tension in unrestrained rats. This method provides stable and continuous measurements of cortical tissue oxygen tension (PO2) for more than 2 weeks and can reproducibly detect acute changes in cortical oxygenation. Exogenous angiotensin-II reduced renal cortical tissue PO2 more than equi-pressor doses of phenylephrine, probably because it reduced renal oxygen delivery more than did phenylephrine. Activation of the endogenous renin-angiotensin system in transgenic Cyp1a1Ren2 rats reduced cortical tissue PO2; in this model renal hypoxia precedes the development of structural pathology and can be reversed acutely by an angiotensin-II receptor type 1 antagonist. Angiotensin-II promotes renal hypoxia, which may in turn contribute to its pathological effects during development of chronic kidney disease. ABSTRACT We hypothesised that both exogenous and endogenous angiotensin-II (AngII) can decrease the partial pressure of oxygen (PO2) in the renal cortex of unrestrained rats, which might in turn contribute to the progression of chronic kidney disease. Rats were instrumented with telemeters equipped with a carbon paste electrode for continuous measurement of renal cortical tissue PO2. The method reproducibly detected acute changes in cortical oxygenation induced by systemic hyperoxia and hypoxia. In conscious rats, renal cortical PO2 was dose-dependently reduced by intravenous AngII. Reductions in PO2 were significantly greater than those induced by equi-pressor doses of phenylephrine. In anaesthetised rats, renal oxygen consumption was not affected, and filtration fraction was increased only in the AngII infused animals. Oxygen delivery decreased by 50% after infusion of AngII and renal blood flow (RBF) fell by 3.3 ml min-1 . Equi-pressor infusion of phenylephrine did not significantly reduce RBF or renal oxygen delivery. Activation of the endogenous renin-angiotensin system in Cyp1a1Ren2 transgenic rats reduced cortical tissue PO2. This could be reversed within minutes by pharmacological angiotensin-II receptor type 1 (AT1 R) blockade. Thus AngII is an important modulator of renal cortical oxygenation via AT1 receptors. AngII had a greater influence on cortical oxygenation than did phenylephrine. This phenomenon appears to be attributable to the profound impact of AngII on renal oxygen delivery. We conclude that the ability of AngII to promote renal cortical hypoxia may contribute to its influence on initiation and progression of chronic kidney disease.
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Affiliation(s)
- Tonja W Emans
- Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands.,Internal Medicine-Nephrology, Academic Medical Centre at the University of Amsterdam, The Netherlands
| | - Ben J Janssen
- Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands
| | | | - Connie P C Ow
- Cardiovascular Disease Program, Biosciences Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biosciences Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Jaap A Joles
- Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Simon C Malpas
- Department of Physiology, University of Auckland, Auckland, New Zealand.,Millar Inc, Auckland, New Zealand
| | - C T Paul Krediet
- Internal Medicine-Nephrology, Academic Medical Centre at the University of Amsterdam, The Netherlands
| | - Maarten P Koeners
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
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