Antithrombin increases pulmonary endothelins: inhibition by heparin and Ca2+ channel antagonism

Endotoxin causes pulmonary hypertension by upregulating smooth muscle endothelin type-B receptors: role of aldose reductase

Endothelin-1 (ET-1), a potent vasoconstrictor and mitogen, is upregulated in pulmonary tissue during endotoxemia and contributes markedly to endotoxin-induced pulmonary hypertension. It is, however, unknown whether the ET receptors, ET(A) and ET(B), are differentially regulated in endotoxemic pulmonary vasculature and how this may impact on pulmonary vascular tone. To investigate this topic, we used isolated perfused lungs, pulmonary endothelial cells (ECs), and pulmonary vascular smooth muscle cells (SMCs) of the rat. During a 6-h endotoxin exposure, isolated perfused lungs developed significant pulmonary hypertension that was markedly attenuated by antagonizing ET(A) or ET(B) receptors using subtype-selective or a mixed ET(A/B) receptor antagonist. Peptide levels of big ET-1 and ET-1 and gene expression of prepro-ET-1 were increased after endotoxin challenge in all tissues. In endotoxemic isolated perfused lungs and ECs, the significant rise of mature ET-1 seen in controls after ET(B) receptor or mixed antagonism disappeared completely. However, this effect was preserved in endotoxemic SMCs. In ECs, endotoxin markedly downregulated maximum ET(B) receptor sites and ET(B) mRNA levels, whereas in SMCs, it generated substantial ET(B) receptor upregulation and moderate ET(A) receptor downregulation. The aldose reductase inhibitors sorbinil and zopolrestat mitigated endotoxin-induced pulmonary hypertension, ET-1 stimulation, and differential ET(B) receptor regulation. We conclude that endotoxin-induced pulmonary hypertension in the rat results from a loss of endothelial and concomitant gain of vascular smooth muscle ET(B) receptors. These changes are at least partly mediated by aldose reductase.

Urinary excretion of endothelin-1 in children with absorptive idiopathic hypercalciuria

Urinary excretion of endothelin-1 (ET-1) and plasma ET-1 were measured in 21 children with absorptive idiopathic hypercalciuria (AIH) and 22 controls. The absorptive type of idiopathic hypercalciuria was determined by a calcium loading test. Daily urinary excretion of ET-1 and urinary ET-1/creatinine ratio were significantly increased ( P=0.005 and P=0.007, respectively) in patients with AIH (9274+/-6444 pg/24 h and 14.04+/-9.52 pg/mg, respectively) compared with controls (4699+/-2120 pg/24 h and 7.36+/-4.71 pg/mg, respectively). Plasma ET-1 levels were significantly lower in patients with AIH (0.84+/-0.64 pg/ml) than in controls (1.54+/-0.54 pg/ml, P=0.0001). In conclusion, patients with AIH had increased urinary ET-1 excretion and decreased plasma ET-1 levels. This is most likely due to the decreased reabsorption of ET-1 in the renal tubule and increased renal production.

Evaluation of unfractionated heparin and recombinant hirudin on survival in a sustained ovine endotoxin shock model

OBJECTIVE

To compare and evaluate the potential benefit of two different anticoagulation regimens during endotoxemia in an ovine model.

DESIGN

Animal prospective randomized and controlled study following preliminary dose-range study conforming with the Guide for the Care and Use of Laboratory Animals as promulgated by the Council of the American Physiologic Society and reviewed by the Ethical Committee for Animal Research of our institution.

SETTING

Laboratories of anesthesiological investigations and hemostasis, primary care university medical center.

SUBJECTS

Twenty-two adult sheep of either sex, weighing 29-42 kg (mean 35.8 kg), surgically instrumented for chronic studies and randomly allocated to receive three different treatment groups: unfractionated heparin (40 units.kg.hr; n = 7), recombinant hirudin (500 units.kg.hr; n = 7), or saline (nonanticoagulated controls; n = 8).

INTERVENTIONS

Ovine model of severe endotoxin shock induced by a continuous intravenous endotoxin infusion over 72 hrs (10 ng.kg.min ).

MEASUREMENTS AND MAIN RESULTS

Endotoxin infusion alone produced a progressive hypotensive, hyperdynamic shock state with right ventricle failure leading to the death of all animals of the control group within 44 hrs (median, 12 hrs). Heparin profoundly improved survival rate in this model, whereas effective anticoagulation with hirudin did not significantly increase the survival rate compared with controls. Animals in the control group died from disseminated intravascular coagulation, metabolic acidosis, and hemorrhagic pulmonary edema, whereas sheep treated with hirudin died from severe pulmonary edema (hypoxemia, increased alveoloarterial oxygen gradient associated with an increased wet/dry lung weight ratio) in the absence of disseminated intravascular coagulation.

CONCLUSIONS

We conclude that systemic anticoagulation with the thrombin inhibitor hirudin is without benefit in this sheep model of lethal endotoxemia, whereas anticoagulation with heparin affords not only effective prevention of endotoxin-induced coagulation disorders but also global protection with prevention of respiratory decompensation and thus markedly improves survival rate in this situation.

Pulmonary adrenomedullin counteracts deterioration of coronary flow and myocardial performance evoked by pulmonary endothelins in experimental acute respiratory distress syndrome

OBJECTIVES

We recently showed that pulmonary endothelins may affect coronary circulation under various experimental and clinical conditions. Here, we investigated the effect of pulmonary mediators on coronary tone in experimental acute respiratory distress syndrome. We focused particularly on pulmonary endothelin-1, a major vasoconstrictor in acute respiratory distress syndrome, and on adrenomedullin, a potent vasodilator that is up-regulated by inflammatory stimuli.

DESIGN

Controlled experiment that used isolated organs.

SETTING

Experimental laboratory.

SUBJECTS

Wistar rats.

INTERVENTIONS

The saline effluent from an isolated lung was used to serially perfuse the coronary vessels of an isolated heart. We compared serial perfusion after 2-hr pretreatment of lungs with vehicle or endotoxin (50 microg/mL), and we used the following drugs to elucidate the coronary response observed: the endothelin type A receptor antagonist BQ-123 (2 microM), the endothelin type B antagonist A-192621 (500 nM), the endothelin-converting enzyme inhibitor phosphoramidon (50 microM), the calcitonin gene-related peptide type-1 receptor antagonist hCGRP(8-37) (2 microM), and the adrenomedullin receptor antagonist hAM(22-52) (200 nM) (n = 6 each).

MEASUREMENTS AND MAIN RESULTS

In controls, serial perfusion decreased coronary flow to 87 +/- 3% of baseline (p < .05). BQ-123 and phosphoramidon prevented this effect, whereas blockade of endothelin type B and adrenomedullin-binding receptors had no effect. After endotoxin challenge, coronary flow significantly increased to 110 +/- 2%. This response was augmented by BQ-123 (124 +/- 2%) and phosphoramidon (123 +/- 3%); A-192621 had no effect. Application of hCGRP(8-37) and hAM(22-52) significantly decreased coronary flow to 81 +/- 3% and 88 +/- 2%, respectively. Flow decrease after blockade of both adrenomedullin-binding receptors (73 +/- 2%) significantly deteriorated peak left ventricular pressure, to 82 +/- 6% of baseline; rate of pressure increase, to 81 +/- 5%; and rate of pressure decline, to 77 +/- 6%. Endotoxin pretreatment elevated pulmonary venous big endothelin-1 (three-fold), endothelin-1 (two-fold), and adrenomedullin (five-fold).

CONCLUSION

In experimental acute respiratory distress syndrome, pulmonary adrenomedullin--via calcitonin gene-related peptide type-1 receptor and adrenomedullin receptor--outweighs the coronary vasoconstrictor impact of pulmonary big endothelin-1 exerted via endothelin type A receptors after conversion to mature endothelin-1. The consequence is prevention of flow-related deterioration of myocardial performance.