Abstract P3047: Soluble Guanylyl Cyclase Stimulators And Activators Inhibit Hypoxia-induced Placental Sflt-1 Levels

Preeclampsia (PE) is a pregnancy-specific disease characterized by placental ischemia, maternal endothelial dysfunction, and hypertension. The ischemic placenta releases anti-angiogenic factors, such as sFlt-1, which antagonizes the angiogenic factors, Placental Growth Factor (PlGF) and Vascular Endothelial Growth Factor (VEGF), causing endothelial dysfunction and impaired nitric oxide (NO) signaling. During normal pregnancy, NO would bind soluble guanylyl cyclase (sGC) increasing cGMP levels leading to vasodilation. However, in PE this signaling is reduced. sGC stimulators and activators are a novel class of drug that directly stimulate sGC despite low levels of NO. Our preliminary data suggest that sGC modulators reduce hypertension in an animal model of PE, but the mechanisms are not known. Therefore, this study tested the hypothesis that sGC stimulators (Riociguat) and activators (Cinaciguat) attenuate sFlt-1 production and increase PlGF levels in the placenta. Placentas were obtained from normal pregnant rats on gestational day 19. Isolated placental villi were plated (1 per well) and coated with Matrix Matrigel Basement Membrane. The villi were treated with various doses of sGC modulators (0.2μM, 1μM, 10μM, 30μM) and then exposed to a hypoxic environment (1% oxygen) for 48 hours. Levels of sFlt-1, PlGF, and VEGF were determined using an Enzyme-Linked Immunosorbent Assay kit.sFlt-1 concentration was significantly reduced in both groups treated with the stimulator or activator compared to the untreated group. The greatest attenuation was observed with the 30μM sGC activator treatment (Untreated, 5117±1313 pg/mL; 30μM sGC stimulator, 3975±621pg/mL, 30μM sGC activator, 3811±712 pg/mL, P<0.05). PlGF was not significantly different between groups, however, VEGF concentrations were significantly increased at higher doses (Untreated, 3099±100 pg/mL; 30μM sGC stimulator, 3871±449 pg/mL 30μM sGC activator, 3952±252 pg/mL; p<0.05). These data suggest that sGC modulators significantly attenuate sFlt-1 and thus, improve the sFlt-1/PlGF and sFlt-1/VEGF ratios. Therefore, a potential mechanism whereby sGC modulators reduce blood pressure in PE is by inhibiting hypoxia-induced placental sFlt-1 levels.

Abstract 039: Blockade of Macula Densa NOS1 Decreases GFR and Promotes the Development of Hypertension During Pregnancy

We hypothesized that neuronal nitric oxide synthesis (NOS1) β in the macula densa promotes the renal hemodynamic changes during normal pregnancy and inhibition of macula densa NOS1 induces hypertension during pregnancy. First, we measured the protein levels of NOS1β in the renal cortex, which increased by 11.5±1.7 folds in pregnant mice (n=5) compared with virgin mice (n=7, p<0.01 vs virgin), while there was no change in NOS1α. Then, in isolated and perfused juxtaglomerular apparatus, we measured tubuloglomerular feedback (TGF)-induced NO generation by the macula densa, which increased by 66.7±6.1% in pregnant mice (n=5) compared with the virgin mice (n=5, p<0.01 vs virgin). We next measured TGF in vivo using micropuncture, which was 3.6±0.3 mmHg in mice at day 19 of pregnancy (n=3) and 5.5±0.7 mmHg in virgin mice (n=7, p<0.05 vs virgin). To determine the significance of the macula densa NOS1, we measured glomerular filtration rate (GFR) and mean arterial pressure (MAP) with telemetry in macula densa specific NOS1 knockout (KO) mice (NKCC2 cre ; NOS1 flox/flox ) and WT (NOS1 flox/flox ) mice. In the WT mice, GFR raised by 25.7±1.1% while the MAP decreased by 6.1±2.7 mmHg at day 18 of pregnancy (n=7, p<0.01). The elevations in GFR were largely blunted in KO mice with only a 13.7±2.8% increase while MAP gradually rose by 28.2±3.3 mmHg above basal level at day 18 of pregnancy (n=5, p<0.05 vs baseline). Finally, we examined macula densa NOS1 in a mouse model of preeclampsia, a reduced uterine perfusion pressure (RUPP) model. At day 19 of pregnancy, the protein levels of NOS1β decreased 71.4±9.6% (n=5), NO generation reduced 26.7±5.8% (n=5) and TGF in vivo increased 41.6±12.2% (n=3) in RUPP mice, compared with normal pregnant mice (p<0.05). Moreover, the MAP or GFR was no significant different between the pregnant KO mice with RUPP and the pregnant KO mice. In conclusion, upregulated macula densa NOS1β blunts TGF response and promotes elevation of GFR during normal pregnancy. In contrast, downregulation of NOS1β in the macula densa enhances the TGF response, decreases GFR and promotes hypertension during pregnancy. These results suggest that inhibition of macula densa NOS1β could be an important mechanism mediating the decrease in GFR and elevation in MAP in preeclampsia.

Hypertension in response to IL-6 during pregnancy: role of AT1-receptor activation

BACKGROUND: Increases in interleukin 6 (IL-6) and agonistic autoantibodies to the angiotensin II type 1 receptor (AT1-AA) are proposed to be important links between placental ischemia and hypertension in preeclampsia. METHODS: The purpose of this study was to determine whether IL-6 (5 ng/day), infused into normal pregnant (NP) rats, increased mean arterial pressure (MAP) and AT1-AA. MAP was analyzed in the presence and absence of an angiotensin type 1 receptor (AT1R) antagonist, losartan, L. RESULTS: MAP and AT1-AA increased from 102 ± 2 to 118 ± 4 mmHg and 0.7 ± 0.3 NP to 14.1 ± 1.4 chronotropic units with chronic IL-6 infusion. MAP responses to IL-6 were abolished in losartan pretreated rats (85 ± 4 in NP + L vs 85 ± 3 mmHg in IL-6 + L). CONCLUSION: These data indicate that IL-6 stimulates AT1-AA and that activation of the AT1R mediates IL-6 induced hypertension during pregnancy.

Role of angiotensin II type I receptor agonistic autoantibodies (AT1-AA) in preeclampsia

Despite being one of the leading causes of maternal death and a major contributor of maternal and perinatal morbidity, the mechanisms responsible for the pathogenesis of preeclampsia are unclear. One important initiating event in preeclampsia is thought to be reduced placental perfusion leading to the production of a variety of factors that cause widespread dysfunction of the maternal vasculature. The major objective of this review is to discuss the potential role of a novel agonistic autoantibody to the angiotensin II type I receptor (AT1-AA) in mediating hypertension during pregnancy. Although animal studies suggest that increasing plasma AT1-AA concentration in pregnant rats to levels observed in preeclamptic women or placental ischemic rats result in significant increases in arterial pressure, the quantitative importance of AT1-AA in the pathophysiology of preeclampsia in humans has yet to be fully elucidated.

Calf stretching in non-weight bearing versus weight bearing

Limited ankle dorsiflexion passive range of motion (DF PROM) has been associated with lower extremity overuse injuries. Therefore, clinicians often prescribe stretching exercises to increase ankle DF PROM. However, there is limited evidence to indicate if any particular gastrocnemius stretching exercise results in greater improvement in DF PROM. The aim of this study was to determine if gastrocnemius stretching in non-weight bearing (NWB) or weight bearing (WB) results in a greater increase of ankle DF PROM. 28 healthy volunteers, aged 18-55 years, who exhibited less than 10 degrees of ankle DF PROM completed the study. Participants were randomized into 2 stretching groups: NWB and WB. Both groups completed a 3-week home gastrocnemius stretching program, consisting of 5 repetitions held for 30 s each, 2 times daily. Participants' ankle DF PROM was measured with a blinded standard goniometer in NWB and WB positions before and after participation in a 3-week home gastrocnemius stretching program. Two 3-way mixed model ANOVAs demonstrated no significant difference in ankle DF PROM between the NWB and WB groups for either the NWB measurement condition (p=0.49) or WB measurement condition (p=0.86). Gastrocnemius stretching exercises performed in NWB or WB were equally effective in increasing ankle DF PROM.

Effects of reduced uterine perfusion pressure on blood pressure and metabolic factors in pregnant rats

BACKGROUND

Elements of metabolic syndrome (eg, dyslipidemia and impaired glucose metabolism) are often present in preeclamptic pregnancies. Currently it is unclear whether these metabolic aberrations presage preeclampsia, or if these manifestations result from placental ischemia and the ensuing proinflammatory state usually present in preeclampsia.

METHODS

The present study employed chronic reductions in uterine perfusion pressure (RUPP) to generate a rat model of pregnancy-induced hypertension (PIH) for the evaluation of fasting plasma concentrations of triglycerides (TGs), glucose, resistin, insulin, and glucose tolerance in late-gestation rats.

RESULTS

Mean arterial pressure was increased (130 +/- 2.1 mm Hg v 100 +/- 4.3 mm Hg; all values, mean +/- SEM), and fetal weight decreased (1.93 +/- 0.08 g v 2.19 +/- 0.06 g), in RUPP dams compared with normal pregnant (NP) control dams. Maternal fasting glucose (4.2 +/- 0.3 mmol L(-1) v 3.1 +/- 0.4 mmol L(-1); P < .05) was increased in RUPP compared with NP dams. Serum TGs (2.62 +/- 0.29 mmol L(-1) v 2.45 +/- 0.51 mmol L(-1)), insulin (9.9 +/- 0.7 microU mL(-1) v 8.5 +/- 0.7 microU mL(-1)), resistin (46.25 +/- 4.19 pg mL(-1) v 49.71 +/- 4.01 pg mL(-1)), and glucose area under the curve (650 +/- 35 mmol min L(-1) v 570 +/- 34 mmol min L(-1)) were not different between the RUPP and NP dams.

CONCLUSIONS

Although these findings do not rule out the hypothesis that preexisting symptoms of metabolic syndrome may contribute to the onset of preeclampsia, these data clearly show that pregnancy-induced hypertension resulting from RUPP does not elicit manifestations of metabolic syndrome in late-gestation rat dams.

A multi-analytical platform approach to the metabonomic analysis of plasma from normal and zucker (fa/fa) obese rats

Plasma obtained from 20 week old normal Wistar-derived and Zucker (fa/fa) rats was analysed using a number of different analytical methodologies to obtain global metabolite profiles as part of metabonomic investigations of animal models of diabetes. Samples were analysed without sample pre-treatment using 1H NMR spectroscopy, after acetonitrile solvent protein precipitation by ultra-performance liquid chromatography-MS (UPLC-MS) and after acetonitrile protein precipitation and derivatisation for capillary gas chromatography-MS (GC-MS). Subsequent data analysis using principal components analysis revealed that all three analytical platforms readily detected differences between the plasma metabolite profiles of the two strains of rat. There was only limited overlap between the metabolites detected by the different methodologies and the combination of all three methods of metabolite profiling therefore provided a much more comprehensive profile than would have been provided by their use individually.

Maternal infection-induced white matter injury is reduced by treatment with interleukin-10

OBJECTIVE

The purpose of this study was to test the hypothesis that interleukin-10 can prevent white matter injury in neonatal rats that are born to infected dams.

STUDY DESIGN

Timed pregnant rats (day 17) were assigned to the following treatment groups: (1) saline control (n = 5 rats), (2) Escherichia coli- infected (n = 10 rats), and (3) E coli + interleukin-10 (n = 5 rats). E coli was administered at a titer of 1 x 10(7) colony-forming units by intrauterine inoculation just above the cervix at the bifurcation of the uterine horns. Rat interleukin-10 was administered intravenously at a dose of 1 microg/kg of body weight. After delivery, the pups were maintained with dams until day 8, at which time they were placed under general anesthesia and perfused with saline solution followed by 10% paraformaldehyde. The brains were removed, placed in 30% sucrose solution, and then frozen at -20 degrees C until the preparation of the frozen sections. Standard hematoxylin/eosin staining was performed, and the brains were evaluated for matter necrosis, apoptotic cells, and ventricular swelling.

RESULTS

In pups that were born to infected dams, 11 of 38 pups (29%) displayed symmetric lesions around the lateral ventricles. These lesions were characterized by marked looseness/edema of the neuropil, foamy-appearing histiocytes, and granular neuropil breakdown. None of the pups (n = 17) that were born to interleukin-10-treated infected dams displayed this pattern of severe white matter injury.

CONCLUSION

These results suggest that maternal interleukin-10 therapy could provide neuroprotection for infants who are born to mothers with intrauterine infection.

Uric acid, endothelial dysfunction and pre-eclampsia

BACKGROUND

Pre-eclampsia is strongly associated with hyperuricemia, and in some studies the increase in serum uric acid has been found to correlate with both maternal and fetal morbidity. The hyperuricemia is believed to result primarily from the decreased renal excretion that occurs as a consequence of the pre-eclampsia, and as such is widely viewed as a marker for pre-eclampsia as opposed to having a role in the pathogenesis.

HYPOTHESIS

We present the hypothesis that hyperuricemia may also have a contributory role in the development of hypertension and renal disease in these patients, and we review recent experimental data that would support this hypothesis.

RECOMMENDATION

We suggest that studies addressing the role of uric acid in pre-eclampsia may provide new insights into both the pathogenesis and treatment of this condition.

A sandwich enzyme-linked immunoabsorbent assay for measurement of picogram quantities of murine granulocyte colony-stimulating factor

Granulocyte colony-stimulating factor (G-CSF) stimulates the proliferation and differentiation of hematopoietic progenitor cells of the neutrophil lineage. Measurement of murine G-CSF levels will allow examination of its role in host defense using murine models. Therefore, we developed a sensitive sandwich enzyme-linked immunoabsorbent assay (ELISA) for murine G-CSF. A polyclonal antibody to recombinant murine G-CSF was produced in rabbits and isolated using a protein A column. This purified native IgG served as the capture antibody and a portion of the IgG was biotinylated to serve as the developing antibody. Specificity was verified by lack of reactivity to GM-CSF, IL-6, IL-3, prolactin, and growth hormone. The lower limit of sensitivity routinely extended to 16 pg/ml in multiple ELISAs. Intra-assay coefficient of variation (CV) ranged from 3.4 to 21.5% across the detection limits of the assay, with the greatest variance occurring near the standard curve maximum. Interassay CV ranged from 11.5 to 23.3%. The ability of the ELISA to detect G-CSF in different sample preparations was examined in RPMI 1640 with 10% FCS, Hanks balanced salt solution, PBS/Tween-20/2% FCS, and the dilution media for ELISA (10% BLOTTO/PBS/0.05% Tween-20). Average recovery in these media ranged from 98 to 107%. Heparin anti-coagulated normal mouse plasma had a suppressive effect on the ELISA that varied between individual mice. Recovery was also determined from liver, spleen, and lung homogenate suspensions at dilutions of 1:5, 1:10, and 1:20 in dilution buffer. Recovery from liver was optimal at the 1:10 and 1:20 dilutions at 105%, with that of the 1:5 dilution at 135%. Recovery from spleen ranged from 94 to 96%. Lung homogenate displayed enhanced recovery (139% or greater) across all dilutions. The ability of the assay to detect G-CSF was explored by measurement of G-CSF levels in peritoneal lavage following polymicrobial intra-abdominal infection. Peak levels of G-CSF production occurred at 16 h after cecal ligation and puncture surgery with 18- and 21-guage needles (75.7 ng/ml and 111.4 ng/ml, respectively) as compared to the sham animals (0.61 ng/ml). The assay was found to be specific, sensitive, and accurate for measurement of murine G-CSF in a variety of sample types.

Promotion of HL-60 cell differentiation by 1,25-dihydroxyvitamin D3 regulation of protein kinase C levels and activity

The hormone 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] promotes differentiation of a number of cell types including HL-60 promyelocytic leukemia cells. It is now established that protein kinase Cbeta (PKCbeta) plays a critical role in HL-60 cell maturation to a monocyte/macrophage phenotype. In the present study, we investigated the importance of PKCbeta levels and activation in 1,25-(OH)2D3-mediated differentiation of HL-60 cells. Cell differentiation promoted by 1,25-(OH)2D3 at 48 hr was 39 +/- 3% (mean +/- SEM) nitroblue tetrazolium (NBT) positive and at 72 hr it was 35 +/- 2% NBT positive and 70% CD14 positive. Thus, promotion of cell differentiation by 20 nM 1,25-(OH)2D3 treatment was maximal at 48-72 hr. When PKCbeta levels and cell differentiation were assayed at 72 hr, treatment with 20 nM 1,25-(OH)2D3 for the initial 6 hr increased PKCbeta levels by 175% but had little effect on cell differentiation (7 +/- 2% NBT positive; 11% CD14 positive). The effect of ionomycin, a calcium ionophore, on PKCbeta levels and cell differentiation also was examined. Alone, 5 microM ionomycin promoted few cells (3% CD14 positive) to differentiate. In contrast, cells treated with 5 microM ionomycin for 66 hr after a 6-hr pretreatment with 20 nM 1,25-(OH)2D3 resulted in 34 +/- 5% NBT positive cells and 73% CD14 positive cells. Quantitatively, this induction of differentiation was identical to that observed in cultures continuously treated with 1,25-(OH)2D3 (35 +/- 2% NBT positive; 70% CD14 positive). Therefore, ionomycin seemed to replace the requirement for the continuous presence of 1,25-(OH)2D3. Chelerythrine chloride (3 microM), a specific PKC inhibitor, blocked differentiation promoted by 1,25-(OH)2D3 alone (82 +/- 2% inhibition) or in sequence with ionomycin (86 +/- 3% inhibition). Taken together, our data show that the capacity of 1,25-(OH)2D3 to both increase PKCbeta levels and activate PKC is utilized to promote HL-60 cell differentiation. These data further suggest that 1,25-(OH)2D3 has a genomic action to increase PKCbeta levels and also a nongenomic action requiring its continuous presence to promote HL-60 cell differentiation.

Role of endothelin in mediating the attenuated renal hemodynamics in Dahl salt-sensitive hypertension

The aim of this study was to evaluate the role of endothelin (ET) in the hypertension associated with giving a high sodium diet in Dahl salt-sensitive (DS) rats. To achieve this goal, we examined the effects of intravenous infusion of the nonspecific ET(A)-ET(B) antagonist on arterial pressure and renal function in conscious, chronically instrumented DS and Dahl salt-resistant (DR) rats. After 3 weeks on a high sodium (8%) diet, mean arterial pressure (MAP) in DS rats (166+/-3 mm Hg) was significantly higher than in DR rats (124+/-3 mm Hg). Baseline glomerular filtration rate (GFR) and renal plasma flow (RPF) in DS rats (1.92+/-0.25 mL/min and 7.07+/-0.80 mL/min) were lower than in DR rats (2.52+/-0.21 mL/min and 7.98+/-0.85 mL/min), respectively. Renal vascular resistance was significantly higher in DS rats (32.78+/-5.88 mm Hg x mL(-1) x min(-1)) than in DR rats (24.60+/-5.04 mm Hg x mL(-1) x min(-1)). Intravenous infusion of the ET antagonist SB 209670 at a dose of 30 microg x kg(-1) x min(-1) for 75 minutes caused a significant decrease in MAP in DS rats (from 166+/-3 to 144+/-4 mm Hg). In contrast, the effect of the ET antagonism on MAP in DR rats was not significant. ET-antagonist infusion tended to improve GFR and RPF in DS but not in DR rats. To determine the renal effects of ET antagonism independent of the systemic hemodynamic responses, we examined the effects of the same ET antagonist in rats chronically implanted with a renal interstitial catheter. Arterial pressure in DS rats (181+/-5 mm Hg) was significantly higher than in DR rats (135+/-3 mm Hg). Renal interstitial infusion of SB 209670 at a dose of 200 ng x kg(-1) x min(-1) for 60 minutes caused no change in MAP in DS or DR rats. Intrarenal ET antagonism significantly increased GFR (25%), RPF (30%), urine flow (32%), and urinary sodium excretion (25%) in DS rats, while it had no significant effect in DR rats. Fractional excretion of sodium was not significantly changed by renal interstitial infusion of the ET antagonist in DS rats, indicating that improved renal excretory function in DS rats is most likely due to the associated improvement in renal hemodynamics. We conclude that ET may play a role in the attenuated renal hemodynamics and possibly the development of Dahl salt-sensitive hypertension.

Role of nitric oxide in modulating the chronic renal and arterial pressure responses to angiotensin II

The purpose of this study was to determine long-term role of nitric oxide in modulating the chronic renal and arterial pressure responses to angiotensin II (AII). In normal dogs, intrarenal AII infusion (1.0 ng/KG/min) decreased renal plasma flow (RPF) by 31% and glomerular filtration rate (GFR) by 17% and increased mean arterial pressure (MAP) by 22%. In dogs with chronic intrarenal NO synthesis blockade with N(omega)-nitro-L-arginine methyl ester (3 micrograms/kg/min), AII decreased RPF by 25% and GFR by 19%, and increased MAP by 7%. These data indicate that chronic inhibition of NO synthesis within the kidney attenuated the long-term renal and arterial pressure responses by AII in dogs.

Role of nitric oxide in modulating the long-term renal and hypertensive actions of norepinephrine

We have previously reported that nitric oxide (NO) plays an important role in protecting the renal vasculature from acute norepinephrine-induced vasoconstriction. The purpose of this study was to determine the importance of this interaction between NO and norepinephrine in long-term control of renal hemodynamics and arterial pressure. To achieve this goal, we examined the effects of an intrarenal infusion of norepinephrine (NE) (0.1 microgram.kg-1.min-1) for 7 days in conscious, chronically instrumented control dogs and in dogs pretreated with a synthesis inhibitor, L-NAME (3 micrograms.kg-1.min-1 intrarenally). Both groups of dogs also received captopril (15 micrograms.kg-1.min-1) plus angiotensin I] intravenously to clamp the renin-angiotensin system throughout the protocol. In control dogs (n = 6), intrarenal infusion of NE decreased renal plasma flow by 9% (134 +/- 10 to 122 +/- 14 mL/min) and glomerular filtration rate by 16% (49 +/- 4 to 41 +/- 5 mL/min) while having no effect on mean arterial pressure (100 +/- 3 to 98 +/- 4 mm Hg). In marked contrast, in dogs pretreated with intrarenal L-NAME (n = 9), NE decreased renal plasma flow by 37% (129 +/- 8 to 81 +/- 16 mL/min) and glomerular filtration rate by 32% (47 +/- 3 to 32 +/- 5 mL/min) while increasing mean arterial pressure from 104 +/- 5 to 113 +/- 6 mm Hg. The results of this study demonstrate that NO plays an important role in modulating the long-term actions of NE on renal function and arterial pressure.

Role of renal nerves in mediating the hypertensive effects of nitric oxide synthesis inhibition

Recent studies suggest that enhanced renal sympathetic nervous activity plays an important role in mediating the renal hemodynamic and electrolyte excretion changes associated with acute inhibition of NO synthesis. The purpose of this study was to determine the importance of renal nerves in mediating the long-term hypertensive and renal actions of NO synthesis blockade. To achieve this goal, we infused N(G)-nitro-L-arginine methyl ester (L-NAME) at a rate of 25 microg/kg per minute for 2 weeks in control dogs and in bilaterally renal-denervated dogs. NO synthesis blockade in control dogs increased arterial pressure by 18%, from 94 +/- 3 to 111 +/- 4 mm Hg, and decreased heart rate from 74 +/- 4 to 57 +/- 4 beats per minute (bpm). L-NAME also decreased renal plasma flow from 195 +/- 18 to 166 +/- 18 mL/min while having no effect on glomerular filtration rate (67 +/- 7 versus 63 +/- 6 mL/min). In the renal-denervated dogs, inhibition of NO synthesis increased arterial pressure by 14%, from 92 +/- 4 to 105 +/- 5 mm Hg, and decreased heart rate from 80 +/- 4 to 65 +/- 5 bpm. Renal plasma flow in this group decreased from 195 +/- 20 to 165 +/- 20 mL/min, whereas glomerular filtration rate remained unchanged (66+/- 6 versus 64 +/- 6 mL/min). In addition, renal excretion of sodium and water in response to L-NAME was similar in each group. The results of this study indicate that the long-term hypertensive and renal effects of NO synthesis inhibition in the dog are not dependent on activation of the renal sympathetic nervous system.