Interactions of nitrovasodilators, atrial natriuretic peptide and endothelium-derived nitric oxide

Sevoflurane Enhances Nitroglycerin Tolerance in Rat Aorta: Implications for the Desensitization of Soluble Guanylate Cyclase Possibly Through the Additive Generation of Superoxide Anions and/or Hydroxyl Radicals Within Vascular Smooth Muscle

Nitroglycerin (TNG) tolerance, defined as an impaired vasodilation response to TNG, has been recently demonstrated to be associated with increased production of reactive species. We designed this study to investigate the mechanisms that mediate TNG tolerance and to compare the effects of sevoflurane and isoflurane on the development of TNG tolerance. Tension changes in rat aortic rings without endothelium were recorded. The cumulative relaxant responses to TNG (10(-8)-10(-5) M) were assessed in phenylephrine-contracted rings. To induce TNG tolerance, the rings were then incubated in the bathing solution containing TNG (10(-5) M) for 30 min in the presence or absence of each anesthetic (1 to 3 MAC). After washout of TNG and anesthetic, the second response to TNG was obtained. Some rings were pretreated with oxygen radical scavengers or sulfhydryl supplements. The first and the second responses to TNG were compared. Sevoflurane at 3 MAC, but not sevoflurane at smaller concentrations or isoflurane, enhanced TNG tolerance when administered in combination with TNG. Sevoflurane alone had no effect on TNG tolerance. The enhancement of TNG tolerance in the case of a combined sevoflurane and TNG treatment was inhibited in the presence of oxygen radical scavengers or at a smaller oxygen concentration (25%). Sevoflurane at a concentration of 3 MAC in hyperoxic condition enhances the development of TNG tolerance, possibly by additive generation of superoxide anions or hydroxyl radicals within vascular smooth muscle.

IMPLICATIONS

The effects of sevoflurane and isoflurane on the development of nitroglycerin (TNG) tolerance were investigated in isolated rat aorta. TNG tolerance was induced by incubation of the vascular tissue in the bathing media containing TNG (10-5 M) for 30 min. Sevoflurane, but not isoflurane, enhances TNG tolerance, possibly by additive generation of oxygen-derived free radicals.

C-type natriuretic peptide decreases soluble guanylate cyclase levels by activating the proteasome pathway

Natriuretic peptides (NP) activate particulate guanylate cyclase (pGC) and nitric oxide (NO) activates soluble guanylate cyclase (sGC). Both guanylate cyclases catalyse the formation of the same second messenger, cyclic guanosine 3',5'-monophosphate (cGMP), which activates the cGMP-dependent protein kinases (PKG). PKG then starts a signalling cascade that mediates many cardiovascular and renal effects, such as smooth muscle relaxation and diuresis. Many cell types possess both sGC and pGC. Because both GC-cGMP systems play complementary roles, an interaction between the two pathways might represent an important physiological control mechanism. In this report we demonstrate an interaction between the two pathways. C-type natriuretic peptide (CNP) decreased the beta-subunit of sGC (sGC-beta) steady-state protein levels and enzymatic activity in cultured human mesangial cells (HMC) in a time- and dose-dependent manner. This down-regulation was not dependent on changes in sGC-beta mRNA levels. Treatment of the cells with the stable cGMP analogue 8-Br-cGMP or the phosphodiesterase type-5 inhibitor Zaprinast produced the same down-regulatory effect. Inhibition of PKG or proteasome activity prevented the CNP-induced reduction of sGC-beta protein levels and activity. Taken together, these results demonstrate that pGC activation induces a post-transductional down-regulation of sGC by a mechanism involving PKG and the proteasome pathway.

Management of Acute Decompensated Heart Failure in the Emergency Department

Heart failure, a disease of epidemic proportions, has a tremendous clinical and financial impact on the US health care system. With more than 5 million Americans diagnosed with heart failure and 5-year mortality approaching 50%, it is the most common cause of hospitalization in patients older than 65 years and is the single most expensive diagnosis in the US health care system. Because the average US hospital loses more than 1000 dollars per heart failure admission, effective therapies that decrease length of stay, reduce hospital costs, and prevent 30-day readmissions are needed. This article reviews the relevant pathophysiology of heart failure, discusses the newest diagnostic strategies for emergency department diagnoses, evaluates recent advances and effects of early aggressive therapies, and presents a suggested algorithm for the treatment of acutely decompensated heart failure in emergency departments.

Natriuretic peptides in relation to the cardiac innervation and conduction system

During the past two decades, the heart has been known to undergo endocrine action, harbouring peptides with hormonal activities. These, termed "atrial natriuretic peptide (ANP)," "brain natriuretic peptide (BNP)," and "C-type natriuretic peptide (CNP)," are polypeptides mainly produced in the cardiac myocardium, where they are released into the circulation, producing profound hypotensive effects due to their diuretic, natriuretic, and vascular dilatory properties. It is, furthermore, well established that cardiac disorders such as congestive heart failure and different forms of cardiomyopathy are combined with increased expression of ANP and BNP, leading to elevated levels of these peptides in the plasma. Besides the occurrence of natriuretic peptides (NPs) in the ordinary myocardium, the presence of ANP in the cardiac conduction system has been described. There is also evidence of ANP gene expression in nervous tissue such as the nodose ganglion and the superior cervical ganglion of the rat, ganglia known to be involved in the neuronal regulation of the heart. Furthermore, in the mammalian heart, ANP appears to affect the cardiac autonomic nervous system by sympathoinhibitory and vagoexcitatory actions. This article provides an overview of the relationship between the cardiac conduction system, the cardiac innervation and NPs in the mammalian heart and provides data for the concept that ANP is also involved in neuronal cardiac regulation.

Two possible mechanisms underlying nitrate tolerance in monkey coronary arteries

1. Previous studies using isolated arteries have demonstrated cross-tolerance between nitric oxide (NO) donors such as nitroglycerin (NTG) and sodium nitroprusside (SNP). However, it remains unclear whether the vasorelaxing effect of atrial natriuretic peptide (ANP), an activator of particulate guanylate cyclase, is affected by treatment with NO donors. To investigate the cross-tolerance and interactions between NTG and ANP in coronary vasorelaxant responses, we used two models of monkey coronary arterial strips (Macaca fuscata). 2. In one model, which was induced by a 1 h treatment with 4.4 x 10(-4) mol/L NTG followed by washout of the agent for 1 h, the vasorelaxing effects of subsequent NTG were markedly attenuated, whereas those of ANP and NO were not affected. These findings suggest that the development of NTG tolerance is associated with a biotransformation process from NTG to NO. In the other model, which did not include washout after exposure to 3 x 10(-6) mol/L NTG, the vasorelaxant responses to 10(-8) mol/L ANP (31.1+/-5.4 vs 5.1+/-2.1%, respectively; P < 0.001), 10(-6) mol/L NO (61.5+/-2.4 vs 29.5+/-8.5%, respectively; P < 0.001) and 10(-8) mol/L SNP (49.4+/-6.4 vs 8.0+/-2.0%, respectively; P < 0.001) were significantly attenuated. The concentration- response curve for 8-bromo-cGMP (8-Br-cGMP) was shifted to the right, whereas responses to papaverine and forskolin were unchanged. These findings suggest that an intracellular process that occurs after the synthesis of cGMP is responsible for this interaction. 3. As a mechanism of NTG tolerance, two possible processes may be impaired: (i) biotransformation from NTG to NO; and (ii) an intracellular process that occurs after the synthesis of cGMP.

Reciprocal regulation of cGMP-mediated vasorelaxation by soluble and particulate guanylate cyclases

Nitric oxide (NO) and atrial natriuretic peptides (ANP) activate soluble (sGC) and particulate guanylate cyclase (pGC), respectively, and play important roles in the maintenance of cardiovascular homeostasis. However, little is known about potential interactions between these two cGMP-generating pathways. Here we demonstrate that sGC and pGC cooperatively regulate cGMP-mediated relaxation in human and murine vascular tissue. In human vessels, the potency of spermine-NONOate (SPER-NO) and ANP was increased after inhibition of endogenous NO synthesis and decreased by prior exposure to glyceryl trinitrate (GTN). Aortas from endothelial NO synthase (eNOS) knockout (KO) mice were more sensitive to ANP than tissues from wild-type (WT) animals. However, in aortas from WT mice, the potency of ANP was increased after pretreatment with NOS or sGC inhibitor. Vessels from eNOS KO animals were less sensitive to ANP after GTN pretreatment, an effect that was reversed in the presence of an sGC inhibitor. cGMP production in response to SPER-NO and ANP was significantly greater in vessels from eNOS KO animals compared with WT animals. This cooperative interaction between NO and ANP may have important implications for human pathophysiologies involving deficiency in either mediator and the clinical use of nitrovasodilators.

Endothelial NO/cGMP system contributes to natriuretic peptide-mediated coronary and peripheral vasodilation

We tested the hypothesis that the endothelial nitric oxide (NO)-soluble guanylyl cyclase system is involved in atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP) mediated regulation of coronary and peripheral vascular resistance. Rat hearts were perfused via the aorta at constant flow and the effect of ANP and CNP on coronary perfusion pressure and release of cGMP was determined in the absence and presence of the nitric oxide synthase inhibitor NG-nitro-L-arginine (L-NNA; 0.2 mmol/L) and the specific inhibitor of soluble guanylyl cyclase ODQ (20 micromol/L), respectively (n = 6). ANP (10-300 nmol/L) reduced perfusion pressure from 133 +/- 2 to 53 +/- 2 mm Hg (-60%; control) in the presence of L-NNA from 132 +/- 1 to 71 +/- 1 mm Hg (-46%) and in the presence of ODQ from 133 +/- 1 to 85 +/- 2 (-36%) (n = 6; P < 0.05). Disruption of the coronary endothelium by perfusion of hearts with collagenase reduced the relaxant effect of ANP to a similar extent as L-NNA. Basal release of cGMP was increased up to sixfold by ANP and this increase was reduced by L-NNA and ODQ (n = 6; P < 0.05). The coronary relaxant effect of CNP (0.1-3 micromol/L) was similarly attenuated by L-NNA and ODQ (n = 6). In conscious mice, a low dose of L-NNA (30 nmol) consistently reduced the blood pressure lowering effect of ANP (30 nmol) by approximately 40% (n = 7), whereas the hypotensive effect of nitroprusside (0.15 micromol) was not affected (n = 5). We conclude that the coronary dilatory and hypotensive action of natriuretic peptides involves the endothelium and is partly mediated by soluble guanylyl cyclase. The data may explain previous observations in humans with congestive heart failure showing impaired vascular ANP responses.

Atrial natriuretic peptide modifies arterial blood pressure through nitric oxide pathway in rats

The aim of the present study was to determine the relationship between the hypotensive effect of the atrial natriuretic peptide (ANP) and the nitric oxide (NO) pathway. N(G)-nitro-L-arginine methyl ester bolus (L-NAME, 1 mg/kg) reverted the decrease in mean arterial pressure induced by ANP administration (5 microg/kg bolus and 0.2 microg x kg(-1) x min(-1) infusion), and the injection of L-NAME before peptide administration suppressed the ANP hypotensive response. To confirm these findings, a histochemical reaction was used to determine NADPH-diaphorase activity (a NO synthase marker) in the endothelium and smooth muscle of aorta and arterioles of the small and large intestine. ANP increased aorta and arteriole endothelium staining after both in vivo administration and in vitro tissue incubation. In both cases, L-NAME prevented the ANP effect on NADPH-diaphorase activity. Tissues incubated with 8-bromoguanosine 3',5'-cyclic monophosphate mimicked ANP action. In addition, ANP administration increased urinary excretion of NO(x) end products. These findings indicate that ANP increases NO synthesis capability and NO production and suggest that the cGMP pathway may be involved. In conclusion, the NO pathway could be an intercellular messenger in the ANP endothelium-dependent vasorelaxation mechanism.

Effects of atrial and brain natriuretic peptides on lysophosphatidylcholine-mediated endothelial dysfunction

Lysophosphatidylcholine (LPC), a major atherogenic lysophospholipid contained in oxidized low-density lipoprotein (ox-LDL), induces endothelial dysfunction. Recent studies showed that natriuretic peptides (NPs) have antiatherogenic properties by inhibiting vascular smooth-muscle cell proliferation, but their effects on endothelial cells are little known. We examined whether atrial and brain NPs (ANP and BNP) have a protecting action against LPC-induced endothelial dysfunction. LPC (10 microM) significantly inhibited thrombin (0.001-1 U/ml)-induced endothelium-dependent relaxation without affecting endothelium-independent relaxation to sodium nitroprusside in isolated porcine coronary arteries. The impaired endothelium-dependent relaxation induced by LPC was prevented by treatment with ANP or BNP (i microM). In cultured bovine aortic endothelial cells (BAECs), LPC (10 microM) significantly attenuated bradykinin (1 microM)-stimulated nitric oxide (NO) release; however, this was prevented by ANP and BNP. Because LPC-induced endothelial dysfunction has been shown to be mediated at least in part by activation of the protein kinase C (PKC)-dependent signaling pathway, we also examined the effects of ANP and BNP on LPC-induced modulation of PKC activities in BAECs. LPC (10 microM) significantly stimulated PKC activity in BAECs. However, ANP or BNP significantly inhibited LPC (10 microM)-induced PKC activation. In conclusion, ANP and BNP protected endothelial cells from LPC-induced dysfunction in both isolated coronary arteries and cultured ECs. The mechanism appears to be at least in part related to the inhibition of LPC-induced PKC activation by NPs. These new actions of ANP and BNP against lysolipid-induced endothelial cytotoxicity may partly account for antiatherogenic properties of NPs.

Comparison of the vasorelaxant effect of nitroprusside and nitroglycerin in the human radial artery in vitro

AIMS

In recent years the radial artery (RA) has been re-introduced for coronary artery bypass grafting (CABG). However, the potential for vasospasm remains a clinical problem when this vessel is employed and effective vasodilator agents are required to combat vasospastic events. This in vitro study was designed to compare the vasodilator effects of sodium nitroprusside (SNP) and nitroglycerin (NTG) in the human RA.

METHODS

Human RA segments (n=70) were taken from vessels employed for grafting in patients undergoing CABG. Concentration-relaxation curves for SNP and NTG were established in RA which had been precontracted with various vasoconstrictors (potassium chloride [K+], the thromboxane A2 mimetic agent U46619 or endothelin-1 [ET-1]).

RESULTS

Both SNP and NTG caused complete relaxation and EC50s were similar except that NTG was 6.2-fold more potent than SNP in U46619-induced contraction (-7.50+/-0.16 vs -6. 71+/-0.38 log m, P=0.04). After treatment with verapamil and NTG solution during harvesting, the RA segments responded with reduced maximal relaxation to NTG (84.9+/-3.9%, compared with 98.8+/-0.8% in the control, P=0.004). The vessel became less sensitive to NTG (EC50: -6.29+/-0.4 vs -7.50+/-0.16 log m, P=0.01). In investigations carried out with SNP, tolerance was only seen in the magnitude of the relaxation (87.4+/-4.7% vs 99.2+/-0.6% in the control, P=0.03).

CONCLUSIONS

Both NTG and SNP are potent vasodilators in the RA. NTG may have more potent effects in certain situations (constriction related to thromboxane A2). However, tolerance to NTG may develop. A cross tolerance to SNP may exist but the effect is weak so that SNP may be preferable to NTG as a vasodilator in the RA postoperatively. Other vasodilators may be the drugs of choice under such circumstances.

Cross-tolerance between endogenous nitric oxide and exogenous nitric oxide donors

It is still unclear whether cross-tolerance develops between endogenously produced nitric oxide and exogenous nitric oxide donors. Thus, cGMP accumulation was determined in cultured aortic smooth muscle cells exposed to a nitric oxide source. Exposure of human, rat, rabbit, porcine or bovine smooth muscle cells to sodium nitroprusside led to a time- and concentration-dependent development of tolerance. In rat aortic smooth muscle cells, cross-tolerance developed between the sodium nitroprusside and S-nitroso-N-acetylpenicillamine, but not between sodium nitroprusside and atriopeptin. In addition, when rat aortic smooth muscle cells were treated with endotoxin or interleukin-1beta, they displayed lower sodium nitroprusside-induced cGMP accumulation as compared to control cells. When rat aortic smooth muscle cells were exposed to sodium nitroprusside for 12 h they displayed a decreased ability to accumulate cGMP in response to endothelium-derived nitric oxide released from bovine aortic endothelial cells. In addition, co-cultures of rat aortic smooth muscle cells with bovine aortic endothelial cells showed an L-nitroarginine methylester-sensitive decrease in sodium nitroprusside-induced cGMP accumulation compared to single rat aortic smooth muscle cell cultures. We conclude that cross-tolerance between endothelium-derived nitric oxide and exogenously applied nitric oxide donors occurs in vitro.