1
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Moriconi D, Mengozzi A, Duranti E, Cappelli F, Taddei S, Nannipieri M, Bruno RM, Virdis A. The renal resistive index is associated with microvascular remodeling in patients with severe obesity. J Hypertens 2023; 41:1092-1099. [PMID: 37071436 PMCID: PMC10242520 DOI: 10.1097/hjh.0000000000003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Renal hemodynamics is impaired since the early stage of cardiometabolic disease. However, in obesity, its noninvasive ultrasound assessment still fails to provide pathophysiologic and clinical meaningfulness. We aimed to explore the relationship between peripheral microcirculation and renal hemodynamics in severe obesity. METHODS We enrolled fifty severely obese patients with an indication for bariatric referring to our outpatient clinic. Patients underwent an extensive reno-metabolic examination, paired with Doppler ultrasound and measurement of the renal resistive index (RRI). On the day of the surgery, visceral fat biopsies were collected to perform an ex-vivo complete microcirculatory assessment. Media-to-lumen ratio (M/L) and vascular response to acetylcholine (ACh), alone or co-incubated with N G -nitro arginine methyl ester (L-NAME), were measured. RESULTS Patients were stratified according to their normotensive (NT) or hypertensive (HT) status. HT had lower estimated glomerular filtration rate and higher RRI compared to NT, while the presence and extent of albuminuria were similar between the two groups. Concerning microcirculatory assessment, there were no differences between groups as regards the microvascular structure, while the vasorelaxation to ACh was lower in HT ( P = 0.042). Multivariable analysis showed a relationship between M/L and RRI ( P = 0.016, St. β 0.37) and between albuminuria and the inhibitory response of L-NAME to Ach vasodilation ( P = 0.036, St. β = -0.34). Notably, all these correlations were consistent also after adjustment for confounding factors. CONCLUSIONS The RRI and albuminuria relationship with microvascular remodeling in patients affected by severe obesity supports the clinical implementation of RRI to improve risk stratification in obesity and suggests a tight pathophysiologic connection between renal haemodynamics and microcirculatory disruption.
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Affiliation(s)
- Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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2
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Mengozzi A, Costantino S, Paneni F, Duranti E, Nannipieri M, Mancini R, Lai M, La Rocca V, Puxeddu I, Antonioli L, Fornai M, Ghionzoli M, Georgiopoulos G, Ippolito C, Bernardini N, Ruschitzka F, Pugliese NR, Taddei S, Virdis* A, Masi S. Targeting SIRT1 Rescues Age- and Obesity-Induced Microvascular Dysfunction in Ex Vivo Human Vessels. Circ Res 2022; 131:476-491. [PMID: 35968712 PMCID: PMC9426744 DOI: 10.1161/circresaha.122.320888] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Experimental evidence suggests a key role of SIRT1 (silent information regulator 1) in age- and metabolic-related vascular dysfunction. Whether these effects hold true in the human microvasculature is unknown. We aimed to investigate the SIRT1 role in very early stages of age- and obesity-related microvascular dysfunction in humans. METHODS Ninety-five subjects undergoing elective laparoscopic surgery were recruited and stratified based on their body mass index status (above or below 30 kg/m2) and age (above or below 40 years) in 4 groups: Young Nonobese, Young Obese, Old Nonobese, and Old Obese. We measured small resistance arteries' endothelial function by pressurized micromyography before and after incubation with a SIRT1 agonist (SRT1720) and a mitochondria reactive oxygen species (mtROS) scavenger (MitoTEMPO). We assessed vascular levels of mtROS and nitric oxide availability by confocal microscopy and vascular gene expression of SIRT1 and mitochondrial proteins by qPCR. Chromatin immunoprecipitation assay was employed to investigate SIRT1-dependent epigenetic regulation of mitochondrial proteins. RESULTS Compared with Young Nonobese, obese and older patients showed lower vascular expression of SIRT1 and antioxidant proteins (FOXO3 [forkhead box protein O3] and SOD2) and higher expression of pro-oxidant and aging mitochondria proteins p66Shc and Arginase II. Old Obese, Young Obese and Old Nonobese groups endothelial dysfunction was rescued by SRT1720. The restoration was comparable to the one obtained with mitoTEMPO. These effects were explained by SIRT1-dependent chromatin changes leading to reduced p66Shc expression and upregulation of proteins involved in mitochondria respiratory chain. CONCLUSIONS SIRT1 is a novel central modulator of the earliest microvascular damage induced by age and obesity. Through a complex epigenetic control mainly involving p66Shc and Arginase II, it influences mtROS levels, NO availability, and the expression of proteins of the mitochondria respiratory chain. Therapeutic modulation of SIRT1 restores obesity- and age-related endothelial dysfunction. Early targeting of SIRT1 might represent a crucial strategy to prevent age- and obesity-related microvascular dysfunction.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.)
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.).,Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland.,Department of Research and Education (F.P.), University Hospital Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Rudj Mancini
- Unit of Bariatric Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (R.M.)
| | - Michele Lai
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy
| | - Veronica La Rocca
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Luca Antonioli
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Matteo Fornai
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Marco Ghionzoli
- Paediatric Surgery Unit, Meyer Children’s Hospital, Florence, Italy (M.G.)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (G.G.).,Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Greece (G.G.)
| | - Chiara Ippolito
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Nunzia Bernardini
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Agostino Virdis*
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
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3
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Application of the Full-Width-at-Half-Maximum Image Segmentation Method to Analyse Retinal Vascular Changes in Patients with Diabetic Retinopathy. JOURNAL OF HEALTHCARE ENGINEERING 2022. [DOI: 10.1155/2022/6726499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study used spectral domain optical coherence tomography (SD-OCT) and full-width-at-half-maximum image segmentation to investigate the morphological changes of retinal blood vessels in patients with diabetic retinopathy (DR). Seventy-five patients with type 2 diabetes mellitus (T2DM) without DR and 65 patients with DR were studied. Vascular images of superior temporal region B of the retina were obtained by SD-OCT. The edges of retinal vessels were identified by the full-width-at-half-maximum image segmentation method. The lumen diameter, wall thickness (WT), wall cross-sectional area (WCSA), and wall-to-lumen ratio (WLR) were investigated. We found that, compared with the no diabetic retinopathy (NDR) group, patients in the DR group had an increased retinal arteriolar lumen diameter (RALD), retinal arteriolar outer diameter (RAOD), and WT (128.80 μm versus 104.88 μm; 147.01 μm versus 135.60 μm; 18.29 μm versus 15.26 μm,
, respectively). The retinal venular lumen diameter (RVLD), retinal venular outer diameter (RVOD), and venular WT in the DR group were also increased (146.17 μm versus 133.66 μm; 180.20 μm versus 156.43 μm; 17.01 μm versus 11.38 μm,
, respectively). The morphological changes in retinal vessels were significantly correlated with DR stage. In conclusion, in diabetic patients with DR, both retinal arteries and veins are widened and exhibit increased vascular thickness.
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4
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Brandt MM, Cheng C, Merkus D, Duncker DJ, Sorop O. Mechanobiology of Microvascular Function and Structure in Health and Disease: Focus on the Coronary Circulation. Front Physiol 2022; 12:771960. [PMID: 35002759 PMCID: PMC8733629 DOI: 10.3389/fphys.2021.771960] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
The coronary microvasculature plays a key role in regulating the tight coupling between myocardial perfusion and myocardial oxygen demand across a wide range of cardiac activity. Short-term regulation of coronary blood flow in response to metabolic stimuli is achieved via adjustment of vascular diameter in different segments of the microvasculature in conjunction with mechanical forces eliciting myogenic and flow-mediated vasodilation. In contrast, chronic adjustments in flow regulation also involve microvascular structural modifications, termed remodeling. Vascular remodeling encompasses changes in microvascular diameter and/or density being largely modulated by mechanical forces acting on the endothelium and vascular smooth muscle cells. Whereas in recent years, substantial knowledge has been gathered regarding the molecular mechanisms controlling microvascular tone and how these are altered in various diseases, the structural adaptations in response to pathologic situations are less well understood. In this article, we review the factors involved in coronary microvascular functional and structural alterations in obstructive and non-obstructive coronary artery disease and the molecular mechanisms involved therein with a focus on mechanobiology. Cardiovascular risk factors including metabolic dysregulation, hypercholesterolemia, hypertension and aging have been shown to induce microvascular (endothelial) dysfunction and vascular remodeling. Additionally, alterations in biomechanical forces produced by a coronary artery stenosis are associated with microvascular functional and structural alterations. Future studies should be directed at further unraveling the mechanisms underlying the coronary microvascular functional and structural alterations in disease; a deeper understanding of these mechanisms is critical for the identification of potential new targets for the treatment of ischemic heart disease.
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Affiliation(s)
- Maarten M Brandt
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Caroline Cheng
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Internal Medicine and Dermatology, Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Walter Brendel Center of Experimental Medicine (WBex), LMU Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Oana Sorop
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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5
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Virk D, Kumar A, Jaggi AS, Singh N. Ameliorative role of rolipram, PDE-4 inhibitor, against sodium arsenite-induced vascular dementia in rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:63250-63262. [PMID: 34226994 DOI: 10.1007/s11356-021-15189-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Arsenic exposure to the population leads to serious health problems like neurotoxicity, nephrotoxicity, and cardiovascular abnormality. In the present study, the work has been commenced to discover the prospect of rolipram a phosphodiestrase-4 (PDE-4) inhibitor against sodium arsenite (SA)-induced vascular endothelial dysfunction (EnDF) leading to dementia in rats. Wistar rats were treated with SA (5 mg/kg body weight/day orally) for 44 days for induction of vascular EnDF and dementia. Learning and memory were evaluated using Morris water maze (MWM) test. Vascular EnDF was evaluated using aortic ring preparation. Various biochemical parameters were also evaluated like brain oxidative stress (viz. reduced glutathione and thiobarbituric acid reactive substances level), serum nitrite/nitrate activity, acetylcholinesterase activity, and inflammatory markers (viz. neutrophil infiltration in brain and myeloperoxidase). SA-treated rats showed poor performance in water maze trials indicating attenuated memory and ability to learn with significant rise (p < 0.05) in brain acetylcholinesterase activity, brain oxidative stress, neutrophil count, and significant decrease (p < 0.05) in serum nitrite/nitrate levels and vascular endothelial functions. Rolipram (PDE-4 inhibitor) treatment (0.03 mg/kg and 0.06 mg/kg body weight, intraperitoneally daily for 14 days) significantly improved memory and learning abilities, and restored various biochemical parameters and EnDF. It is concluded that PDE-4 modulator may be considered the prospective target for the treatment of SA-induced vascular EnDF and related dementia.
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Affiliation(s)
- Divjot Virk
- Department of Pharmaceutical Sciences and Drug Research, CNS Research Lab., Pharmacology Division, Faculty of Medicine, Punjabi University, Patiala, Punjab, 147002, India
| | - Amit Kumar
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India.
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, CNS Research Lab., Pharmacology Division, Faculty of Medicine, Punjabi University, Patiala, Punjab, 147002, India
| | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, CNS Research Lab., Pharmacology Division, Faculty of Medicine, Punjabi University, Patiala, Punjab, 147002, India.
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6
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Masi S, Rizzoni D, Taddei S, Widmer RJ, Montezano AC, Lüscher TF, Schiffrin EL, Touyz RM, Paneni F, Lerman A, Lanza GA, Virdis A. Assessment and pathophysiology of microvascular disease: recent progress and clinical implications. Eur Heart J 2021; 42:2590-2604. [PMID: 33257973 PMCID: PMC8266605 DOI: 10.1093/eurheartj/ehaa857] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/23/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
The development of novel, non-invasive techniques and standardization of protocols to assess microvascular dysfunction have elucidated the key role of microvascular changes in the evolution of cardiovascular (CV) damage, and their capacity to predict an increased risk of adverse events. These technical advances parallel with the development of novel biological assays that enabled the ex vivo identification of pathways promoting microvascular dysfunction, providing novel potential treatment targets for preventing cerebral-CV disease. In this article, we provide an update of diagnostic testing strategies to detect and characterize microvascular dysfunction and suggestions on how to standardize and maximize the information obtained from each microvascular assay. We examine emerging data highlighting the significance of microvascular dysfunction in the development CV disease manifestations. Finally, we summarize the pathophysiology of microvascular dysfunction emphasizing the role of oxidative stress and its regulation by epigenetic mechanisms, which might represent potential targets for novel interventions beyond conventional approaches, representing a new frontier in CV disease reduction.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Institute of Cardiovascular Science, University College London, London, UK
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Division of Medicine, Istituto Clinico Città di Brescia, Brescia, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Robert Jay Widmer
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Augusto C Montezano
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Thomas F Lüscher
- Heart Division, Royal Brompton and Harefield Hospital and Imperial College, London, UK.,Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Rhian M Touyz
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zürich, Switzerland
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Gaetano A Lanza
- Department of Cardiovascular and Thoracic Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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7
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Hughes WE, Zinkevich N, Gutterman DD, Beyer AM. Hypertension preserves the magnitude of microvascular flow-mediated dilation following transient elevation in intraluminal pressure. Physiol Rep 2021; 9:e14507. [PMID: 33587335 PMCID: PMC7883808 DOI: 10.14814/phy2.14507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to measure flow-mediated dilation (FMD) prior to and following transient increases in intraluminal pressure (IILP) in resistance arterioles isolated from subjects with and without coronary artery disease (CAD) (CAD and non-CAD) and non-CAD subjects with hypertension. METHODS Arterioles were isolated from discarded surgical tissues (adipose and atrial) from patients without coronary artery disease (non-CAD; ≤1 risk factor, excluding hypertension), with CAD, and non-CAD patients with hypertension (hypertension as the only risk factor). To simulate transient hypertension, increased IILP was generated (150 mmHg, 30 min) by gravity. Arterioles were constricted with endothelin-1, followed by FMD and endothelial-independent dilation prior to and following exposure to IILP. RESULTS IILP reduced FMD in non-CAD and CAD arterioles relative to pre-IILP (p <.05 at 100 cmH2 O). In contrast, arterioles from non-CAD hypertensive subjects exhibited no reduction in maximal FMD following IILP (p = .84 at 100 cmH2 O). FMD was reduced by L-NAME prior to IILP in non-CAD hypertensive patients (p < .05 at 100 cmH2 O); however, following IILP, FMD was inhibited by peg-cat (p < .05 at 100 cmH2 O), indicating a switch from NO to H2 O2 as the mechanism of dilation. CONCLUSIONS Acute exposure (30 min) to IILP (150 mmHg) attenuates the magnitude of FMD in non-CAD and CAD resistance arterioles. The presence of clinically diagnosed hypertension in non-CAD resistance arterioles preserves the magnitude of FMD following IILP as a result of a compensatory switch from NO to H2 O2 as the mechanism of dilation.
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Affiliation(s)
- William E. Hughes
- Department of MedicineMedical College of WisconsinMilwaukeeWIUSA
- Cardiovascular CenterMedical College of WisconsinMilwaukeeWIUSA
| | - Natalya Zinkevich
- Cardiovascular CenterMedical College of WisconsinMilwaukeeWIUSA
- Department of Health and MedicineCarroll UniversityWaukeshaWIUSA
| | - David D. Gutterman
- Department of MedicineMedical College of WisconsinMilwaukeeWIUSA
- Cardiovascular CenterMedical College of WisconsinMilwaukeeWIUSA
- Department of PhysiologyMedical College of WisconsinMilwaukeeWIUSA
| | - Andreas M. Beyer
- Department of MedicineMedical College of WisconsinMilwaukeeWIUSA
- Cardiovascular CenterMedical College of WisconsinMilwaukeeWIUSA
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8
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Abstract
Healthy vascular endothelial cells regulate vascular tone and permeability, prevent vessel wall inflammation, enhance thromboresistance, and contribute to general vascular health. Furthermore, they perform important functions including the production of vasoactive substances such as nitric oxide (NO) and endothelium-derived hyperpolarizing factors, as well as the regulation of smooth muscle cell functions. Conversely, vascular endothelial dysfunction leads to atherosclerosis, thereby enhancing the risk of stroke, myocardial infarction, and other cardiovascular diseases (CVDs). Observational studies and randomized trials showed that green tea intake was inversely related to CVD risk. Furthermore, evidence indicates that epigallocatechin gallate (EGCG) found in green tea might exert a preventive effect against CVDs. EGCG acts as an antioxidant, inducing NO release and reducing endothelin-1 production in endothelial cells. EGCG enhances the bioavailability of normal NO by reducing levels of the endogenous NO inhibitor asymmetric dimethylarginine. Furthermore, it inhibits the enhanced expression of adhesion molecules such as vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 and attenuates monocyte adhesion. In addition, EGCG prevents enhanced oxidative stress through the Nrf2/HO-1 pathway. These effects indicate that it might prevent the production of reactive oxygen species, inhibit inflammation, and reduce endothelial cell apoptosis during the initial stages of atherosclerosis. The current review summarizes recent research in this area and discusses novel findings regarding the protective effect of EGCG on endothelial dysfunction and CVDs in general.
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9
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Masi S, Georgiopoulos G, Chiriacò M, Grassi G, Seravalle G, Savoia C, Volpe M, Taddei S, Rizzoni D, Virdis A. The importance of endothelial dysfunction in resistance artery remodelling and cardiovascular risk. Cardiovasc Res 2020; 116:429-437. [PMID: 31220219 DOI: 10.1093/cvr/cvz096] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/20/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS The relationship between resistance artery remodelling and endothelial function remains unknown. In this study, we assessed (i) the capacity of endothelial function and nitric oxide (NO) availability to provide more information on the severity of resistance artery remodelling than common cardiovascular risk factors in subjects at low or high cardiovascular risk; and (ii) differences between patterns of resistance artery remodelling associated with deficit of NO availability and with exposure to cardiovascular risk factors. METHODS AND RESULTS All analyses were conducted on the microvascular data set of the Italian Society for Arterial Hypertension (SIIA) that includes 356 patients with measures of small resistance arteries remodelling acquired with pressure or wire myography. Information on endothelial function and NO availability were also available in 116 patients. The European Heart Score (HS) was used to define the total cardiovascular risk of each patient. Endothelial function was inversely related with the severity of the resistance artery remodelling, and this association remained significant after adjustment for the HS. By contrast, the HS lost its significant association with the media-to-lumen (M/L) ratio and the media cross-sectional area after adjustment for endothelial function. The strength of these associations was similar in subjects at high and low cardiovascular risk. The addition of endothelial function and NO availability to the HS significantly improved the identification of subjects at more and less severe resistance artery remodelling. A severe deficit of NO availability was associated with hypertrophic remodelling, while a higher HS was more clearly associated with eutrophic remodelling. CONCLUSION Resistance artery endothelial function and NO availability might represent important factors involved in resistance artery remodelling, independently from cardiovascular risk factor exposure.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, Università degli Studi di Pisa, Via Roma 67, 56126 Pisa, Italy.,National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, UK.,Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Georgios Georgiopoulos
- First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Martina Chiriacò
- Department of Clinical and Experimental Medicine, Università degli Studi di Pisa, Via Roma 67, 56126 Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy.,Unit of Cardiology and Cardiovascular Science, IRCCS Multimedica, Sesto san Giovanni, Milan, Italy
| | - Gino Seravalle
- Cardiology Unit, Fondazione Istituto Auxologico Italiano, Ospedale S. Luca, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carmine Savoia
- Cardiology Division, Clinical and Molecular Medicine Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Volpe
- Cardiology Division, Clinical and Molecular Medicine Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed - Mediterranean Neurological Institute, Pozzilli, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, Università degli Studi di Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Brescia, Italy.,Division of Medicine, Istituto Clinico Città di Brescia, Brescia, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, Università degli Studi di Pisa, Via Roma 67, 56126 Pisa, Italy
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Effect of direct renin inhibition on vascular function after long-term treatment with aliskiren in hypertensive and diabetic patients. J Hypertens 2020; 39:169-180. [PMID: 32740409 DOI: 10.1097/hjh.0000000000002595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We tested the hypothesis that chronic treatment with the direct renin inhibitor aliskiren improves vascular function in resistance and conduit arteries of type two diabetic and hypertensive patients. METHOD Sixteen patients with mild essential hypertension and with a previous diagnosis of noninsulin-dependent diabetes mellitus were included in the study. Patients were then randomized to aliskiren (150 mg once daily, n = 9), or ramipril (5 mg once daily, n = 7). Each patient underwent a biopsy of the subcutaneous tissue and small arteries were dissected and mounted on a pressurized micromyograph to evaluate endothelium dependent vasorelaxation in response to acetylcholine ± N omega-nitro-L-arginine methyl ester hydrochloride in vessels precontracted with norepinephrine. Endothelial function has been quantified also in large conduit arteries by flow-mediated dilation. RESULTS A similar office blood pressure-lowering effect was observed with the two drugs, although changes in DBP were not statistically significant in the ramipril group. Aliskiren significantly improved endothelium-dependent relaxation in subcutaneous resistance arteries, as well as increased flow-mediated dilation in conduit arteries, whereas the effects induced by ramipril did not reach statistical significance. Only aliskiren significantly increased the expression of p1177-endothelial nitric oxide synthase in the endothelium. Both aliskiren and ramipril had a negligible effect on markers of oxidative stress. CONCLUSION Aliskiren restored endothelial function and induced a more prompt peripheral vasodilation in hypertensive and diabetic patients possibly through the increased production of nitric oxide via the enhanced expression and function of the active phosphorylated form of endothelial nitric oxide synthase.
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Taguchi K, Bessho N, Hasegawa M, Narimatsu H, Matsumoto T, Kobayashi T. Co-treatment with clonidine and a GRK2 inhibitor prevented rebound hypertension and endothelial dysfunction after withdrawal in diabetes. Hypertens Res 2018; 41:263-274. [DOI: 10.1038/s41440-018-0016-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/28/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
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Khavandi K, Aghamohammadzadeh R, Luckie M, Brownrigg J, Alam U, Khattar R, Malik RA, Heagerty AM, Greenstein AS. Abnormal Remodeling of Subcutaneous Small Arteries Is Associated With Early Diastolic Impairment in Metabolic Syndrome. J Am Heart Assoc 2017; 6:JAHA.116.004603. [PMID: 28400366 PMCID: PMC5532992 DOI: 10.1161/jaha.116.004603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Small artery pathophysiology is frequently invoked as a cause of obesity‐related diastolic heart failure. However, evidence to support this hypothesis is scant, particularly in humans. Methods and Results To address this, we studied human small artery structure and function in obesity and looked for correlations between vascular parameters and diastolic function. Seventeen obese patients with metabolic syndrome and 5 control participants underwent echocardiography and subcutaneous gluteal fat biopsy. Small arteries were isolated from the biopsy and pressure myography was used to study endothelial function and wall structure. In comparison with the control group, small arteries from obese participants exhibited significant endothelial dysfunction, assessed as the vasodilatory response to acetylcholine and also pathological growth of the wall. For the obese participants, multiple regression analysis revealed an association between left atrial volume and both the small artery wall thickness (β=0.718, P=0.02) and wall‐to‐lumen ratio (β=0.605, P=0.02). Furthermore, the E:E′ ratio was associated with wall‐to‐lumen ratio (β=0.596, P=0.02) and inversely associated with interleukin‐6 (β=−0.868, P=0.03). By contrast, endothelial function did not correlate with any of the echocardiographic parameters studied. Conclusions Although the small arteries studied were not cardiac in origin, our results support a role for small artery remodeling in the development of diastolic dysfunction in humans. Further direct examination of the structure and function of the myocardial resistance vasculature is now warranted, to elucidate the temporal association between metabolic risk factors, small artery injury, and diastolic impairment.
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Affiliation(s)
- Kaivan Khavandi
- Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester, United Kingdom.,British Heart Foundation Centre of Excellence, The Rayne Institute, King's College London, London, United Kingdom
| | - Reza Aghamohammadzadeh
- Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester, United Kingdom
| | - Matthew Luckie
- Manchester Heart Centre, Central Manchester Teaching Hospitals Foundation Trust, Manchester, United Kingdom
| | - Jack Brownrigg
- St. George's Vascular Institute, St George's, University of London, United Kingdom
| | - Uazman Alam
- Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester, United Kingdom
| | - Rajdeep Khattar
- Department of Cardiology, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Anthony M Heagerty
- Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester, United Kingdom
| | - Adam S Greenstein
- Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester, United Kingdom
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Bruno RM, Duranti E, Ippolito C, Segnani C, Bernardini N, Di Candio G, Chiarugi M, Taddei S, Virdis A. Different Impact of Essential Hypertension on Structural and Functional Age-Related Vascular Changes. Hypertension 2017; 69:71-78. [DOI: 10.1161/hypertensionaha.116.08041] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/02/2016] [Accepted: 10/07/2016] [Indexed: 02/07/2023]
Abstract
We evaluated whether vascular remodeling is present in physiological aging and whether hypertension accelerates the aging process for vascular function and structure. Small arteries from 42 essential hypertensive patients (HT) and 41 normotensive individuals (NT) were dissected after subcutaneous biopsy. Endothelium-dependent vasodilation (pressurized myograph) was assessed by acetylcholine, repeated under the nitric oxide synthase inhibitor
N
-nitro-
l
-arginine methylester or the antioxidant tempol. Structure was evaluated by media–lumen ratio (M/L). Intravascular oxidative generation and collagen deposition were assessed. Inhibition by
N
-nitro-
l
-arginine methylester on ACh was inversely related to age in both groups (
P
<0.0001) and blunted in HT versus NT for each age range. In NT, tempol enhanced endothelial function in the oldest subgroup; in HT, the potentiating effect started earlier. HT showed an increased M/L (
P
<0.001) versus control. In both groups, M/L was directly related to age (
P
<0.0001). M/L was greater in HT, starting from 31 to 45 years range. A significant age–hypertension interaction occurred (
P
=0.0009). In NT, intravascular superoxide emerged in the oldest subgroup, whereas it appeared earlier among HT. Among NT, aged group displayed an increment of collagen fibers versus young group. In HT, collagen deposition was already evident in youngest, with a further enhancement in the aged group. In small arteries, ageing shows a eutrophic vascular remodeling and a reduced nitric oxide availability. Oxidative stress and fibrosis emerge in advanced age. In HT, nitric oxide availability is early reduced, but the progression rate with age is similar. Structural alterations include wide collagen deposition and intravascular reactive oxygen species, and the progression rate with age is steeper.
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Affiliation(s)
- Rosa Maria Bruno
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Emiliano Duranti
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Chiara Ippolito
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Cristina Segnani
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Nunzia Bernardini
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Giulio Di Candio
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Massimo Chiarugi
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Stefano Taddei
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
| | - Agostino Virdis
- From the Histology Unit (C.I., C.S., N.B.), Internal Medicine Unit (R.M.B., E.D., S.T., A.V.) of Department of Clinical and Experimental Medicine, Emergency Surgery Unit (M.C.) of Department of Surgery, Medical, Molecular, and Critical Area Pathology, and General Surgery Unit (G.D.C.) of Department of Oncology Transplantation and New Technologies, University of Pisa, Italy
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Bosetti F, Galis ZS, Bynoe MS, Charette M, Cipolla MJ, Del Zoppo GJ, Gould D, Hatsukami TS, Jones TLZ, Koenig JI, Lutty GA, Maric-Bilkan C, Stevens T, Tolunay HE, Koroshetz W. "Small Blood Vessels: Big Health Problems?": Scientific Recommendations of the National Institutes of Health Workshop. J Am Heart Assoc 2016; 5:JAHA.116.004389. [PMID: 27815267 PMCID: PMC5210346 DOI: 10.1161/jaha.116.004389] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Francesca Bosetti
- National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Zorina S Galis
- National Heart, Lung and Blood Institute, National Institutes of Health (NIH), Bethesda, MD
| | | | - Marc Charette
- National Heart, Lung and Blood Institute, National Institutes of Health (NIH), Bethesda, MD
| | | | | | | | | | - Teresa L Z Jones
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD
| | - James I Koenig
- National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | | | - Christine Maric-Bilkan
- National Heart, Lung and Blood Institute, National Institutes of Health (NIH), Bethesda, MD
| | | | - H Eser Tolunay
- National Heart, Lung and Blood Institute, National Institutes of Health (NIH), Bethesda, MD
| | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
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García-Redondo AB, Aguado A, Briones AM, Salaices M. NADPH oxidases and vascular remodeling in cardiovascular diseases. Pharmacol Res 2016; 114:110-120. [PMID: 27773825 DOI: 10.1016/j.phrs.2016.10.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 02/07/2023]
Abstract
Reactive oxygen species (ROS) are key signaling molecules that regulate vascular function and structure in physiological conditions. A misbalance between the production and detoxification of ROS increases oxidative stress that is involved in the vascular remodeling associated with cardiovascular diseases such as hypertension by affecting inflammation, hypertrophy, migration, growth/apoptosis and extracellular matrix protein turnover. The major and more specific source of ROS in the cardiovascular system is the NADPH oxidase (NOX) family of enzymes composed of seven members (NOX1-5, DUOX 1/2). Vascular cells express several NOXs being NOX-1 and NOX-4 the most abundant NOXs present in vascular smooth muscle cells. This review focuses on specific aspects of NOX-1 and NOX-4 isoforms including information on regulation, function and their role in vascular remodeling. In order to obtain a more integrated view about the role of the different NOX isoforms in different types of vascular remodeling, we discuss the available literature not only on hypertension but also in atherosclerosis, restenosis and aortic dilation.
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Affiliation(s)
- Ana B García-Redondo
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28029, Madrid, Spain
| | - Andrea Aguado
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28029, Madrid, Spain
| | - Ana M Briones
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28029, Madrid, Spain.
| | - Mercedes Salaices
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28029, Madrid, Spain.
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16
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17
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Effects of age, blood pressure and antihypertensive treatments on retinal arterioles remodeling assessed by adaptive optics. J Hypertens 2016; 34:1115-22. [DOI: 10.1097/hjh.0000000000000894] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Solini A, Rossi C, Duranti E, Taddei S, Natali A, Virdis A. Saxagliptin prevents vascular remodeling and oxidative stress in db/db mice. Role of endothelial nitric oxide synthase uncoupling and cyclooxygenase. Vascul Pharmacol 2016; 76:62-71. [DOI: 10.1016/j.vph.2015.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/23/2015] [Accepted: 10/04/2015] [Indexed: 12/17/2022]
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19
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Tong YH, Zhu TP, Zhao ZL, Zhan HJ, Jiang FZ, Lian HL. Retinal Arteriolar Morphometry Based on Full Width at Half Maximum Analysis of Spectral-Domain Optical Coherence Tomography Images. PLoS One 2015; 10:e0144437. [PMID: 26650940 PMCID: PMC4674079 DOI: 10.1371/journal.pone.0144437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/18/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In this study, we develop a microdensitometry method using full width at half maximum (FWHM) analysis of the retinal vascular structure in a spectral-domain optical coherence tomography (SD-OCT) image and present the application of this method in the morphometry of arteriolar changes during hypertension. METHODS Two raters using manual and FWHM methods measured retinal vessel outer and lumen diameters in SD-OCT images. Inter-rater reproducibility was measured using coefficients of variation (CV), intraclass correlation coefficient and a Bland-Altman plot. OCT images from forty-three eyes of 43 hypertensive patients and 40 eyes of 40 controls were analyzed using an FWHM approach; wall thickness, wall cross-sectional area (WCSA) and wall to lumen ratio (WLR) were subsequently calculated. RESULTS Mean difference in inter-rater agreement ranged from -2.713 to 2.658 μm when using a manual method, and ranged from -0.008 to 0.131 μm when using a FWHM approach. The inter-rater CVs were significantly less for the FWHM approach versus the manual method (P < 0.05). Compared with controls, the wall thickness, WCSA and WLR of retinal arterioles were increased in the hypertensive patients, particular in diabetic hypertensive patients. CONCLUSIONS The microdensitometry method using a FWHM algorithm markedly improved inter-rater reproducibility of arteriolar morphometric analysis, and SD-OCT may represent a promising noninvasive method for in vivo arteriolar morphometry.
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Affiliation(s)
- Yu Hua Tong
- Quzhou People's Hospital, Quzhou Central Hospital of Zhejiang Chinese Medical University, Quzhou, Zhejiang Province, China
| | - Tie Pei Zhu
- Eye Center of Affiliated Second Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang Province, China
- * E-mail:
| | - Ze Lin Zhao
- Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital, Wenzhou, Zhejiang Province, China
| | - Hai Jing Zhan
- Quzhou People's Hospital, Quzhou Central Hospital of Zhejiang Chinese Medical University, Quzhou, Zhejiang Province, China
| | - Fang Zheng Jiang
- Quzhou People's Hospital, Quzhou Central Hospital of Zhejiang Chinese Medical University, Quzhou, Zhejiang Province, China
| | - Heng Li Lian
- Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital, Wenzhou, Zhejiang Province, China
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20
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21
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Nyberg M, Gliemann L, Hellsten Y. Vascular function in health, hypertension, and diabetes: effect of physical activity on skeletal muscle microcirculation. Scand J Med Sci Sports 2015; 25 Suppl 4:60-73. [DOI: 10.1111/sms.12591] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 12/31/2022]
Affiliation(s)
- M. Nyberg
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - L. Gliemann
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - Y. Hellsten
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
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22
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Volpe M, Battistoni A, Savoia C, Tocci G. Understanding and treating hypertension in diabetic populations. Cardiovasc Diagn Ther 2015; 5:353-63. [PMID: 26543822 DOI: 10.3978/j.issn.2223-3652.2015.06.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertension and diabetes frequently occurs in the same individuals in clinical practice. Moreover, the presence of hypertension does increase the risk of new-onset diabetes, as well as diabetes does promote development of hypertension. Whatever the case, the concomitant presence of these conditions confers a high risk of major cardiovascular complications and promotes the use integrated pharmacological interventions, aimed at achieving the recommended therapeutic targets. While the benefits of lowering abnormal fasting glucose levels in patients with hypertension and diabetes have been consistently demonstrated, the blood pressure (BP) targets to be achieved to get a benefit in patients with diabetes have been recently reconsidered. In the past, randomized clinical trials have, indeed, demonstrated that lowering BP levels to less than 140/90 mmHg was associated to a substantial reduction of the risk of developing macrovascular and microvascular complications in hypertensive patients with diabetes. In addition, epidemiological and clinical reports suggested that "the lower, the better" for BP in diabetes, so that levels of BP even lower than 130/80 mmHg have been recommended. Recent randomized clinical trials, however, designed to evaluate the potential benefits obtained with an intensive antihypertensive therapy, aimed at achieving a target systolic BP level below 120 mmHg as compared to those obtained with less stringent therapy, have challenged the previous recommendations from international guidelines. In fact, detailed analyses of these trials showed a paradoxically increased risk of coronary events, mostly myocardial infarction, in those patients who achieved the lowest BP levels, particularly in the high-risk subsets of hypertensive populations with diabetes. In the light of these considerations, the present article will briefly review the common pathophysiological mechanisms, the potential sites of therapeutic interactions and the currently recommended BP targets to be achieved under pharmacological treatment in hypertension and diabetes.
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Affiliation(s)
- Massimo Volpe
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
| | - Allegra Battistoni
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
| | - Carmine Savoia
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giuliano Tocci
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
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Husarek KE, Katz PS, Trask AJ, Galantowicz ML, Cismowski MJ, Lucchesi PA. The angiotensin receptor blocker losartan reduces coronary arteriole remodeling in type 2 diabetic mice. Vascul Pharmacol 2015; 76:28-36. [PMID: 26133668 DOI: 10.1016/j.vph.2015.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/09/2015] [Accepted: 06/27/2015] [Indexed: 01/02/2023]
Abstract
Cardiovascular complications are a leading cause of morbidity and mortality in type 2 diabetes mellitus (T2DM) and are associated with alterations of blood vessel structure and function. Although endothelial dysfunction and aortic stiffness have been documented, little is known about the effects of T2DM on coronary microvascular structural remodeling. The renin-angiotensin-aldosterone system plays an important role in large artery stiffness and mesenteric vessel remodeling in hypertension and T2DM. The goal of this study was to determine whether the blockade of AT1R signaling dictates vascular smooth muscle growth that partially underlies coronary arteriole remodeling in T2DM. Control and db/db mice were given AT1R blocker losartan via drinking water for 4 weeks. Using pressure myography, we found that coronary arterioles from 16-week db/db mice undergo inward hypertrophic remodeling due to increased wall thickness and wall-to-lumen ratio with a decreased lumen diameter. This remodeling was accompanied by decreased elastic modulus (decreased stiffness). Losartan treatment decreased wall thickness, wall-to-lumen ratio, and coronary arteriole cell number in db/db mice. Losartan treatment did not affect incremental elastic modulus. However, losartan improved coronary flow reserve. Our data suggest that Ang II-AT1R signaling mediates, at least in part, coronary arteriole inward hypertrophic remodeling in T2DM without affecting vascular mechanics, further suggesting that targeting the coronary microvasculature in T2DM may help reduce cardiac ischemic events.
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Affiliation(s)
- Kathryn E Husarek
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; School of Biomedical Science, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Paige S Katz
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Aaron J Trask
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Maarten L Galantowicz
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Mary J Cismowski
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Pamela A Lucchesi
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
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Yildirim M, Simavli SA, Uysal Derbent A, Kaygusuz I, Uysal S. Is There Any Relationship between Plasma Pentraxin 3 Levels and Gestational Diabetes Mellitus? Gynecol Obstet Invest 2015; 80:223-7. [DOI: 10.1159/000373889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022]
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26
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De Ciuceis C, Savoia C, Arrabito E, Porteri E, Mazza M, Rossini C, Duse S, Semeraro F, Agabiti Rosei C, Alonzo A, Sada L, La Boria E, Sarkar A, Petroboni B, Mercantini P, Volpe M, Rizzoni D, Agabiti Rosei E. Effects of a Long-Term Treatment With Aliskiren or Ramipril on Structural Alterations of Subcutaneous Small-Resistance Arteries of Diabetic Hypertensive Patients. Hypertension 2014; 64:717-24. [DOI: 10.1161/hypertensionaha.114.03380] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Structural alterations of subcutaneous small-resistance arteries are associated with a worse clinical prognosis in hypertension and non–insulin-dependent diabetes mellitus. The effects of the direct renin inhibitor aliskiren on microvascular structure were never previously evaluated. Therefore, we investigated the effects of aliskiren in comparison with those of an extensively used angiotensin-converting enzyme inhibitor, ramipril, on peripheral subcutaneous small-resistance artery morphology, retinal arteriolar structure, and capillary density in a population of patients with non–insulin-dependent diabetes mellitus. Sixteen patients with mild essential hypertension and with a previous diagnosis of non–insulin-dependent diabetes mellitus were included in the study. Patients were then randomized to 1 of the 2 active treatments (aliskiren 150 mg once daily, n=9; or ramipril 5 mg once daily, n=7). Each patient underwent a biopsy of the subcutaneous fat from the gluteal region, an evaluation of retinal artery morphology (scanning laser Doppler flowmetry), and capillary density (capillaroscopy), at baseline and after 1 year of treatment. Subcutaneous small arteries were dissected and mounted on a pressurized micromyograph, and the media-to-lumen ratio was evaluated. A similar office blood pressure–lowering effect and a similar reduction of the wall-to-lumen ratio of retinal arterioles were observed with the 2 drugs. Aliskiren significantly reduced media-to-lumen ratio of subcutaneous small-resistance arteries, whereas ramipril-induced reduction of media to lumen ratio was not statistically significant. No relevant effect on capillary density was observed. In conclusion, treatment with aliskiren or ramipril was associated with a correction of microvascular structural alterations in patients with non–insulin-dependent diabetes mellitus.
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Affiliation(s)
- Carolina De Ciuceis
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Carmine Savoia
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Emanuele Arrabito
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Enzo Porteri
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Mazza
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudia Rossini
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Sarah Duse
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesco Semeraro
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudia Agabiti Rosei
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandro Alonzo
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Lidia Sada
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elisa La Boria
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Annamaria Sarkar
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Beatrice Petroboni
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Mercantini
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Volpe
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Damiano Rizzoni
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Enrico Agabiti Rosei
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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27
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Leoniuk J, Lukasiewicz A, Szorc M, Sackiewicz I, Janica J, Lebkowska U. Doppler ultrasound detection of preclinical changes in foot arteries in early stage of type 2 diabetes. Pol J Radiol 2014; 79:283-9. [PMID: 25202434 PMCID: PMC4156336 DOI: 10.12659/pjr.890486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/16/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There are few reports regarding the changes within the vessels in the initial stage of type 2 diabetes. The aim of this study was to estimate the hemodynamic and morphological parameters in foot arteries in type 2 diabetes subjects and to compare these parameters to those obtained in a control group of healthy volunteers. MATERIAL/METHODS Ultrasound B-mode, color Doppler and pulse wave Doppler imaging of foot arteries was conducted in 37 diabetic patients and 36 non-diabetic subjects to determine their morphological (total vascular diameter and flow lumen diameter) and functional parameters (spectral analysis). RESULTS In diabetic patients, the overall vascular diameter and wall thickness were statistically significantly larger when compared to the control group in the right dorsalis pedis artery (P=0.01; P=0.001), left dorsalis pedis artery (P=0.007; P=0.006), right posterior tibial artery (P=0.005; P=0.0005), and left posterior tibial artery (P=0.007; P=0.0002). No significant differences were observed in both groups in flow lumen diameters and blood flow parameters (PSV, EDV, PI, RI). In the diabetic group, the level of HbA1c positively correlated with flow resistance index in the right dorsalis pedis artery (r=0.38; P=0.02), right posterior tibial artery (r=0.38; P=0.02) and left posterior tibial artery (r=0.42; P=0.009). The pulsatility index within the dorsalis pedis artery decreased with increased trophic skin changes (r=-0.431, P=0.009). CONCLUSIONS In the diabetic group, overall artery diameters larger than and flow lumina comparable to the control group suggest vessel wall thickening occurring in the early stage of diabetes. Doppler flow parameters are comparable in both groups. In the diabetic group, the level of HbA1c positively correlated with flow resistance index and negative correlation was observed between the intensity of trophic skin changes and the pulsatility index.
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Affiliation(s)
- Jolanta Leoniuk
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Adam Lukasiewicz
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Małgorzata Szorc
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Izabela Sackiewicz
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Jacek Janica
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Urszula Lebkowska
- Department of Radiology, Medical University of Białystok, Białystok, Poland
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28
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Krüger K, Klocke R, Kloster J, Nikol S, Waltenberger J, Mooren FC. Activity of daily living is associated with circulating CD34+/KDR+ cells and granulocyte colony-stimulating factor levels in patients after myocardial infarction. J Appl Physiol (1985) 2014; 116:532-7. [DOI: 10.1152/japplphysiol.01254.2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The study aimed to investigate whether the extent of activities of daily living (ADL) of patients after myocardial infarction affect numbers of circulating CD34+/KDR+ and CD45+/CD34+ cells, which are supposed to protect structural and functional endothelial integrity. In a cross-sectional study, 34 male coronary artery disease patients with a history of myocardial infarction were assessed for times spent per week for specific physical ADL, including basic activities (instrumental ADL), leisure time activities, and sport activities, using a validated questionnaire. Individual specific activity times were multiplied with respective specific metabolic equivalent scores to obtain levels of specific activities. Numbers of circulating CD34+/KDR+ and CD45+/CD34+ cells were analyzed by flow cytometry. Furthermore, the colony-forming capacity of CD34+ cells and the level of granulocyte colony-stimulating factor (G-CSF) in serum were measured. Analysis revealed that the extent of total activities and basic activities, as well as total activity time, were positively correlated with numbers of circulating CD34+/KDR+ cells ( r = 0.60, 0.56, and 0.55, P < 0.05). Higher levels of total activity were also associated with increased colony-forming capacity of CD34+ cells ( r = 0.54, P < 0.05) and with higher systemic levels of G-CSF ( r = 0.44, P < 0.05). These findings indicate that even ADL-related activities of coronary artery disease patients after myocardial infarction exert stimulating effects on CD34+/KDR+ cell mobilization, potentially mediated by increased G-CSF levels. This, in turn, potentially contributes to the beneficial effects of exercise on the diseased cardiovascular system.
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Affiliation(s)
- Karsten Krüger
- Department of Sports Medicine, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany; and
| | - Rainer Klocke
- Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Julia Kloster
- Department of Sports Medicine, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany; and
| | - Sigrid Nikol
- Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | | | - Frank C. Mooren
- Department of Sports Medicine, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany; and
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29
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Virdis A, Duranti E, Rossi C, Dell'Agnello U, Santini E, Anselmino M, Chiarugi M, Taddei S, Solini A. Tumour necrosis factor-alpha participates on the endothelin-1/nitric oxide imbalance in small arteries from obese patients: role of perivascular adipose tissue. Eur Heart J 2014; 36:784-94. [PMID: 24578389 DOI: 10.1093/eurheartj/ehu072] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/02/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS We assessed the impact of vascular and perivascular tumour necrosis factor-alpha (TNF-α) on the endothelin (ET)-1/nitric oxide (NO) system and the molecular pathways involved in small arteries from visceral fat of obese patients (Obese) and Controls. METHODS AND RESULTS Isolated small arteries from 16 Obese and 14 Controls were evaluated on a pressurized micromyograph. Endogenous ET-1 activity was assessed by the ETA blocker BQ-123. TNF-α and NO were tested by anti-TNF-α infliximab (IFX) and N(ω)-nitro-l-arginine methylester (L-NAME). Gene and protein expression of TNF-α, ET-1, ETA, and ETB receptors were determined by RT-PCR and IHC on arterial wall and in isolated adipocytes. Obese showed a blunted L-NAME-induced vasoconstriction, which was potentiated by IFX, and an increased relaxation to BQ-123, unaffected by L-NAME but attenuated by IFX. Perivascular adipose tissue (PVAT) removal reversed these effects. Obese showed intravascular superoxide excess, which was decreased by apocynin (NAD(P)H oxidase inhibitor), L-NAME, and BQ-123 incubations, and abolished by IFX. An increased vascular expression of ET-1, ETA, and ETB receptors, and higher vascular/perivascular TNF-α and TNF-α receptor expression were also detected. The arterial expression and phosphorylation of c-Jun N-terminal kinase (JNK) were higher in Obese vs. Controls, and downregulated by IFX. CONCLUSIONS In small arteries of Obese, PVAT-derived TNF-α excess, and an increased vascular expression of ET-1 and ETA receptor, contribute to the ET-1/NO system imbalance, by impairing tonic NO release. Reactive oxygen species excess, via NAD(P)H oxidase activation, induces the endothelial nitric oxide synthase uncoupling, which in turn generates superoxide and impairs NO production. The up-regulated JNK pathway represents a crucial molecular signalling involved in this process.
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Affiliation(s)
- Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Chiara Rossi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Umberto Dell'Agnello
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Eleonora Santini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | | | - Massimo Chiarugi
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Anna Solini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
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30
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Zini E, Benali S, Coppola L, Guscetti F, Ackermann M, Lutz TA, Reusch CE, Aresu L. Renal Morphology in Cats With Diabetes Mellitus. Vet Pathol 2014; 51:1143-50. [DOI: 10.1177/0300985813516645] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In humans, diabetes mellitus (DM) is an important cause of renal damage, with glomerular lesions being predominant. In cats, although diabetes is a common endocrinopathy, it is yet unknown whether it leads to renal damage. The aim of the study was to compare renal histologic features and parameters of renal function in diabetic cats against a control population matched for age, gender, breed, and body weight. Thirty-two diabetic and 20 control cats were included. Kidney sections from paraffin-embedded kidney samples were stained and examined with optical microscopy to identify glomerular, tubulointerstitial, and vascular lesions and to assess their frequency and severity. Serum creatinine and urea concentrations were also compared. Glomerular lesions were observed in 29 cats overall, with mesangial matrix increase being more common (19 cats). Tubulointerstitial lesions were observed in 42 cats, including lymphocytic infiltration (29), fibrosis (22), or tubular necrosis (21). Vascular lesions were observed in 5 cases. The frequency and severity of histologic lesions did not differ between diabetic and control cats; however, among diabetics, those that survived longer after diagnosis had more glomerular and vascular lesions. Serum creatinine and urea concentrations were similar between groups; in diabetic cats median creatinine was 109 μmol/l (range, 51–1200) and urea was 12 mmol/l (range, 4–63), and in controls creatinine was 126 μmol/l (range, 50–875) and urea 11 mmol/l (range, 3–80). The results suggest that DM in cats does not lead to microscopically detectable kidney lesions or clinically relevant renal dysfunction. The authors hypothesize that the short life expectancy of diabetic cats may be the main reason for the difference from human diabetics.
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Affiliation(s)
- E. Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse, Zurich, Switzerland
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
- Istituto Veterinario di Novara, Novara, Italy
| | - S. Benali
- Department of Comparative Biomedicine and Food Sciences, University of Padova, Padova, Italy
| | - L. Coppola
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - F. Guscetti
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M. Ackermann
- Institute of Virology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - T. A. Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C. E. Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse, Zurich, Switzerland
| | - L. Aresu
- Department of Comparative Biomedicine and Food Sciences, University of Padova, Padova, Italy
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31
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Virdis A, Bacca A, Colucci R, Duranti E, Fornai M, Materazzi G, Ippolito C, Bernardini N, Blandizzi C, Bernini G, Taddei S. Endothelial Dysfunction in Small Arteries of Essential Hypertensive Patients. Hypertension 2013; 62:337-44. [DOI: 10.1161/hypertensionaha.111.00995] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Essential hypertensive patients show a reduced nitric oxide availability secondary to oxidative stress generation in peripheral microcirculation. Cyclooxygenase (COX) contributes to reduce nitric oxide availability. We assessed the possible vascular sources of oxidative stress, including COX-1, COX-2, and nicotinamide adenine dinucleotide phosphate oxidase, as determinants of endothelial dysfunction in small arteries isolated from essential hypertensive patients or normotensive controls. Small arteries were dissected after subcutaneous fat biopsies and evaluated on a pressurized micromyograph. Endothelium-dependent vasodilation was assessed by acetylcholine, repeated under NG-nitro-
l
-arginine methyl ester, SC-560 (COX-1 inhibitor), DuP-697 (COX-2 inhibitor), ascorbic acid, or the nicotinamide adenine dinucleotide phosphate oxidase inhibitors apocynin or diphenylene iodonium. Vascular oxidative stress generation (fluorescent dihydroethidium), COX-1 and COX-2 expression (Western blot), and localization (immunohistochemistry) were also assessed. In controls, response to acetylcholine was blunted by NG-nitro-
l
-arginine methyl ester (
P
<0.001) and unmodified by SC-560, DuP-697, or ascorbic acid. In hypertensive patients, relaxation to acetylcholine was blunted, resistant to NG-nitro-
l
-arginine methyl ester or SC-560, and enhanced (
P
<0.01) by DuP-697, apocynin, or diphenylene iodonium (
P
<0.05). Furthermore, in hypertensive patients, response to acetylcholine was normalized by ascorbic acid or apocynin+DuP-697. Intravascular oxidative stress generation was enhanced in hypertensive patients, decreased (
P
<0.01) by DuP-697, partly attenuated by apocynin or diphenylene iodonium, and prevented by ascorbic acid. Enhanced COX-2 expression and localization in the vascular media of hypertensive patients were also detected. In small resistance arteries of essential hypertensive patients, COX-2 is overexpressed and reduces nitric oxide availability. COX-2 represents a major source of oxidative stress generation, whereas nicotinamide adenine dinucleotide phosphate oxidase plays a minor, but significant, role in promoting superoxide generation.
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Affiliation(s)
- Agostino Virdis
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Alessandra Bacca
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Rocchina Colucci
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Emiliano Duranti
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Matteo Fornai
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Chiara Ippolito
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Nunzia Bernardini
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Corrado Blandizzi
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Giampaolo Bernini
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
| | - Stefano Taddei
- From the Department of Clinical and Experimental Medicine (A.V., A.B., R.C., E.D., M.F., C.I., N.B., C.B., G.B., S.T.) and Department of Surgery (G.M.), University of Pisa, Pisa, Italy
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Affiliation(s)
- Carmine Savoia
- Carmine Savoia is Associate Professor of Cardiology, Cardiology Unit and Chair, Clinical and Molecular Medicine Department, Sapienza University of Rome, Italy. After a fellowship in Ernesto Schiffrin’s laboratory, he has continued his research on pathophysiology of hypertension, vascular remodeling and cardiovascular damage, the renin–angiotensin–aldosterone system, and clinical studies in diabetic and/or hypertensive patients
| | - Ernesto L Schiffrin
- Ernesto L Schiffrin is Physician-in-Chief, Jewish General Hospital, Canada Research Chair in Hypertension and Vascular Research, Lady Davis Institute for Medical Research, and Professor and Vice-Chair (Research), Department of Medicine, McGill University (Montreal, Canada). His research deals with vascular remodeling in hypertension, renal and cardiometabolic diseases, from mice to humans, and the influence of the renin–angiotensin–aldosterone and endothelin systems, nuclear receptors and immunity on
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The vascular phenotypes in hypertension: Relation with the natural history of hypertension. ACTA ACUST UNITED AC 2012; 1:56-67. [PMID: 20409833 DOI: 10.1016/j.jash.2006.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 11/10/2006] [Indexed: 11/23/2022]
Abstract
The different vascular phenotypes found in hypertension comprise different aspects. They may be clinical, diagnostic, structural, mechanical, functional, cellular and extracellular, signaling and molecular, proteomic, and gene expression phenotypes. In this manuscript the emphasis will be on the various structure, mechanics, dysfunction, and cell and signaling changes that can be demonstrated in hypertension, and particularly in human hypertension. The phenotype relates to the natural history of hypertension, increasingly elucidated on the basis of cohort studies. The evolution from pre-hypertension to diastolic, systolic, and systo-diastolic hypertension may have a vascular substratum that could explain, in part, the prevalence of each of these phenotypes. The potential for intervention to prevent the passage from pre-hypertension to hypertension thanks to therapies that modulate the development of vascular remodeling is highlighted.
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Freidja ML, Tarhouni K, Toutain B, Fassot C, Loufrani L, Henrion D. The AGE-breaker ALT-711 restores high blood flow-dependent remodeling in mesenteric resistance arteries in a rat model of type 2 diabetes. Diabetes 2012; 61:1562-72. [PMID: 22415880 PMCID: PMC3357287 DOI: 10.2337/db11-0750] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Flow-mediated remodeling of resistance arteries is essential for revascularization in ischemic diseases, but this is impaired in diabetes. We hypothesized that breaking advanced glycation end product (AGE) cross-links could improve remodeling in mesenteric resistance arteries in Zucker diabetic fatty (ZDF) rats compared with lean Zucker (LZ) rats. Arteries, exposed to high (HF) or normal (NF) blood flow after alternate arterial ligation in vivo, were collected after 2 weeks. In LZ rats, HF artery diameter was larger than for NF vessels, but this was not the case in ZDF rats. Endothelium-mediated dilation in ZDF rats, which was lower than in LZ rats, was further decreased in HF arteries. Treatment of rats with the AGE-breaker 4,5-dimethyl-3-phenacylthiazolium chloride (ALT-711) (3 mg/kg/day; 3 weeks) reversed diabetes-induced impairment of HF-dependent remodeling. ALT-711 also improved endothelium nitric oxide-dependent relaxation in mesenteric resistance arteries. Reactive oxygen species reduction restored relaxation in ZDF rats but not in LZ or ALT-711-treated rats. AGEs were reduced in ALT-711-treated ZDF rats compared with ZDF rats. Metalloproteinase activity, necessary for HF-dependent remodeling, was reduced in ZDF rats compared with LZ rats and restored by ALT-711. Thus, targeting AGE cross-links may provide a therapeutic potential for overcoming microvascular complications in ischemic disorders occurring in diabetes.
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Khalili A, Nekooeian AA, Khosravi MB, Fakher S. Simultaneous renal hypertension and type 2 diabetes exacerbate vascular endothelial dysfunction in rats. Int J Exp Pathol 2012; 93:210-7. [PMID: 22458508 DOI: 10.1111/j.1365-2613.2012.00811.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Despite the high rate of occurrence of both diabetes and hypertension in humans, the cardiovascular effects of the two conditions have not been investigated when they occur simultaneously. Thus this study examined the vascular effects of simultaneous type 2 diabetes and renal hypertension on endothelial function. Serum malondialdehyde and systolic blood pressure (SBP) were measured, glucose tolerance test (GTT) was performed, and concentration-response to phenylephrine (PE) in the absence and presence of nitro-l-arginine methyl ester (l-NAME), acetylcholine and sodium nitroprusside were conducted on aortic rings from diabetic control, type 2 diabetes, sham-operated, renal hypertensive, and simultaneous type 2 diabetes plus hypertension rats respectively. Hypertension, diabetes, and simultaneous diabetes and hypertension were associated with either increased or decreased maximal responses (E(max)) of PE dependent on in the presence or absence of l-NAME. There was also increased serum malondialdehyde and decreased E(max) of acetylcholine. Thus simultaneous hypertension and diabetes caused a greater decrease in E(max) of acetylcholine compared to that seen with either diabetes or hypertension alone higher than that seen in hypertension. The blood glucose during GTT was lower than that seen in diabetes groups. Thus simultaneous type 2 diabetes and the SBP was renal hypertension is associated with improved glucose tolerance, but with further deterioration of endothelial dysfunction compared with either condition alone.
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Affiliation(s)
- Azadeh Khalili
- Department of Pharmacology, Cardiovascular Pharmacology Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Affiliation(s)
- Ernesto L. Schiffrin
- From the Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital and Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, McGill University, Montreal, Québec, Canada
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Effect of treatment on cardiac small resistance arteries in hypertension and diabetes: trick or treat. J Hypertens 2012; 30:271-2. [PMID: 22236969 DOI: 10.1097/hjh.0b013e32834ea491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Virdis A, Taddei S. How to Evaluate Microvascular Organ Damage in Hypertension. High Blood Press Cardiovasc Prev 2011; 18:163-7. [DOI: 10.2165/11593630-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Small artery function 2 years postpartum in women with altered glycaemic distributions in their preceding pregnancy. Clin Sci (Lond) 2011; 122:53-61. [PMID: 21745185 DOI: 10.1042/cs20110033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
GDM (gestational diabetes mellitus) is associated with later adverse cardiovascular risk. The present study examined the relationship between glycaemia during pregnancy and small artery function and structures approx. 2 years postpartum. Women were originally enrolled in the HAPO (Hyperglycaemia and Adverse Pregnancy Outcome) study from which they were classified by their glycaemic distribution during pregnancy as controls (in the lower half of the distribution), UQ (upper quartile; in the UQ of the glycaemic distribution) or having had overt GDM. Subcutaneous arteries from a gluteal fat biopsy taken at follow-up 2 years later were examined using wire myography. Small artery structure, stiffness and vasoconstrictor responses were similar across groups. Maximal endothelium-dependent dilation in response to carbachol was impaired in arteries from both GDM (43.3%, n=8 and P=0.01) and UQ (51.7%, n=13 and P=0.04) women despite generally 'normal' current glycaemia (controls, 72.7% and n=8). Inhibition of NOS (nitric oxide synthase) significantly reduced maximum endothelium-dependent dilation in controls but had no effect on arteries from UQ and GDM women, suggesting impaired NOS activity in these groups. Endothelium-independent dilation was unaffected in arteries from previous GDM and UQ women when compared with the control group. Multiple regression analysis suggested that BMI (body mass index) at biopsy was the most potent factor independently associated with small artery function, with no effect of current glycaemia. Overweight women with either GDM or marginally raised glycaemia during pregnancy (our UQ group) had normal vascular structure and stiffness, but clearly detectable progressively impaired endothelium-dependent function at 2 years follow-up. These results suggest that vascular pathology, which may still be reversible, is detectable very early in women at risk of decline into Type 2 diabetes mellitus.
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Vascular Generation of Tumor Necrosis Factor-α Reduces Nitric Oxide Availability in Small Arteries From Visceral Fat of Obese Patients. J Am Coll Cardiol 2011; 58:238-47. [DOI: 10.1016/j.jacc.2011.01.050] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/15/2010] [Accepted: 01/11/2011] [Indexed: 01/13/2023]
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Vascular protection in diabetic stroke: role of matrix metalloprotease-dependent vascular remodeling. J Cereb Blood Flow Metab 2010; 30:1928-38. [PMID: 20664613 PMCID: PMC3002883 DOI: 10.1038/jcbfm.2010.120] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Temporary focal ischemia causes greater hemorrhagic transformation (HT) in diabetic Goto-Kakizaki (GK) rats, a model with increased cerebrovascular matrix metalloprotease (MMP) activity and tortuosity. The objective of the current study was to test the hypotheses that (1) diabetes-induced cerebrovascular remodeling is MMP dependent and (2) prevention of vascular remodeling by glucose control or MMP inhibition reduces HT in diabetic stroke. Control and GK rats were treated with vehicle, metformin, or minocycline for 4 weeks, and indices of remodeling including vascular tortuosity index, lumen diameter, number of collaterals, and middle cerebral artery (MCA) MMP activity were measured. Additional animals were subjected to 3 hours MCA occlusion/21 hours reperfusion, and infarct size and HT were evaluated as indices of neurovascular injury. All remodeling markers including MMP-9 activity were increased in diabetes. Infarct size was smaller in minocycline-treated animals. Both metformin and minocycline reduced vascular remodeling and severity of HT in diabetes. These results provide evidence that diabetes-mediated stimulation of MMP-9 activity promotes cerebrovascular remodeling, which contributes to greater HT in diabetes. Metformin and minocycline offer vascular protection, which has important clinical implications for diabetes patients who are at a fourfold to sixfold higher risk for stroke.
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Abstract
The aim of this article is to briefly review available data regarding changes in the structure of microvessels observed in patients with diabetes mellitus, and possible correction by effective treatment. The development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, small arteries of smooth muscle cells are restructured around a smaller lumen and there is no net growth of the vascular wall, although in some secondary forms of hypertension, a hypertrophic remodelling may be detected. Moreover, in non-insulin-dependent diabetes mellitus a hypertrophic remodelling of subcutaneous small arteries is present. Indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive and diabetic patients, over and above all other known cardiovascular risk factors. Therefore, regression of vascular alterations is an appealing goal of antihypertensive treatment. Different antihypertensive drugs seem to have different effect on vascular structure. In diabetic hypertensive patients, a significant regression of structural alterations of small resistance arteries with drugs blocking the renin–angiotensin system (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers) was demonstrated. Alterations in the microcirculation represent a common pathological finding, and microangiopathy is one of the most important mechanisms involved in the development of organ damage as well as of clinical events in patients with diabetes mellitus. Renin–angiotensin system blockade seems to be effective in preventing/regressing alterations in microvascular structure.
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Affiliation(s)
- Enrico Agabiti Rosei
- Department of Medical and Surgical Sciences, University of Brescia, Clinica Medica, Brescia, Italy
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Greenstein AS, Paranthaman R, Burns A, Jackson A, Malik RA, Baldwin RC, Heagerty AM. Cerebrovascular damage in late-life depression is associated with structural and functional abnormalities of subcutaneous small arteries. Hypertension 2010; 56:734-40. [PMID: 20713917 DOI: 10.1161/hypertensionaha.110.152801] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late-life depression is increasingly viewed as a vascular illness because of patients exhibiting characteristic white matter brain lesions and in vivo large artery endothelial dysfunction. However, the "vascular depression" hypothesis pertains to the microvasculature, and this circulation has not been studied in this context. Our objective was to examine structure and function of small subcutaneous arteries in patients with late-life depression. Thus, 16 patients aged 71.8±4.0 years with late-life depression were compared with 15 control participants aged 72.1±5.9 years. There were similar cardiovascular profiles between the 2 groups. All of the participants underwent MRI brain scans and subcutaneous gluteal fat biopsy from which small arteries were isolated and studied using pressure myography. Cerebral microvascular damage in depressed patients was confirmed by assessment of basal ganglia Virchow-Robin space scores (depressed patients 3.9±1.7 versus controls: 2.5±1.6; P=0.01). Contractility to norepinephrine was equivalent in both groups, but relaxation of the small arteries to acetylcholine was significantly reduced in depressed patients (84.0±4.0%) compared with control participants (96.0±1.4%; P=0.012). This difference in arterial relaxation was reduced but not entirely eliminated when NO synthase was inhibited. Depressed patients also exhibited hypertrophic wall growth with an increase in medial cross-sectional area (P=0.035, multiple ANOVA and wall thickness; P=0.04, multiple ANOVA). In conclusion, despite similar cardiovascular profiles, depressed patients with cerebral microvascular damage show abnormalities of subcutaneous small artery structure and function.
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Agabiti-Rosei E, Rizzoni D. Regression of Small Resistance Artery Structural Alterations in Hypertension by Appropriate Antihypertensive Treatment. Curr Hypertens Rep 2010; 12:80-5. [DOI: 10.1007/s11906-010-0093-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grassi G, Seravalle G, Scopelliti F, Dell'Oro R, Fattori L, Quarti-Trevano F, Brambilla G, Schiffrin EL, Mancia G. Structural and functional alterations of subcutaneous small resistance arteries in severe human obesity. Obesity (Silver Spring) 2010; 18:92-8. [PMID: 19521345 DOI: 10.1038/oby.2009.195] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obese persons are at increased cardiovascular risk and exhibit increased arterial stiffness and impaired endothelial function of large- and medium-size arteries. We hypothesized that normotensive subjects suffering from severe obesity would also present remodeling and endothelial dysfunction of small resistance arteries. A total of 16 lean (age: 49.6 +/- 2.9 years, BMI: 22.9 +/- 0.3 kg/m(2), mean +/- s.e.m.) and 17 age-matched severely obese (BMI: 41.1 +/- 2.3 kg/m(2)) normotensive subjects were investigated. None had glucose or lipid metabolic abnormalities except for insulin resistance. Resistance arteries, dissected from abdominal subcutaneous tissue, were assessed on a pressurized myograph. For superimposable blood pressure, the media thickness, media cross-sectional area (CSA), and media-to-lumen ratio values of resistance arteries were markedly and significantly greater in obese compared to lean subjects (media thickness 26.3 +/- 0.6 vs. 16.2 +/- 0.6 microm, CSA 22,272 +/- 1,339 vs. 15,183 +/- 1,186 microm(2), and media-to-lumen ratio 0.113 +/- 0.006 vs. 0.059 +/- 0.001, respectively, P < 0.01). Acetylcholine-induced relaxation was impaired in vessels from obese subjects compared to the lean individuals (-40.4 +/- 1.3%, P < 0.01), whereas endothelium-independent vasorelaxation was similar in all groups. Stiffness of small arteries as assessed by the stress/strain relationship was similar in lean and severely obese subjects. We conclude that severe human obesity is associated with profound alterations in structural and functional characteristics of small arteries, which may be responsible for the presence of elevated cardiovascular risk and increased incidence of coronary, cerebrovascular and renal events reported in obesity.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Milan, Italy.
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Rizzoni D, Porteri E, De Ciuceis C, Rodella LF, Paiardi S, Rizzardi N, Platto C, Boari GEM, Pilu A, Tiberio GAM, Giulini SM, Favero G, Rezzani R, Rosei CA, Bulgari G, Avanzi D, Rosei EA. Hypertrophic remodeling of subcutaneous small resistance arteries in patients with Cushing's syndrome. J Clin Endocrinol Metab 2009; 94:5010-8. [PMID: 19864447 DOI: 10.1210/jc.2009-1588] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Structural alterations of small resistance arteries in essential hypertensive patients (EH) are mostly characterized by inward eutrophic remodeling. However, we observed hypertrophic remodeling in patients with renovascular hypertension, in those with acromegaly, as well as in patients with non-insulin-dependent diabetes mellitus, suggesting a relevant effect of humoral growth factors on vascular structure, even independent from the hemodynamic load. Cortisol may stimulate the renin-angiotensin system and may induce cardiac hypertrophy. However, presently no data are available about small artery structure in patients with Cushing's syndrome. SUBJECTS We have investigated the structure of sc small resistance arteries in 12 normotensive subjects (NT), in 12 EH subjects, and in eight patients with Cushing's syndrome (CS). Small arteries from sc fat were dissected and mounted on a micromyograph. The normalized internal diameter, media thickness, media to lumen ratio, and the media cross-sectional area were measured, as well as indices of oxidative stress. RESULTS Demographic variables were similar in the three groups, except for clinic blood pressure. The media to lumen ratio was significantly greater in EH and CS, compared with NT; no difference was observed between EH and CS. The media cross-sectional area was significantly greater in CS compared with EH and with NT. An increased vascular oxidative stress was present in CS, as demonstrated by increased levels of superoxide anions, cyclooxygenase-1 and endothelial nitric oxide synthase in the microvessels. CONCLUSION Our results suggest the presence of hypertrophic remodeling in sc small resistance arteries of CS, probably as a consequence of growth-promoting properties of circulating cortisol and/or increased vascular oxidative stress.
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Affiliation(s)
- Damiano Rizzoni
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2 Medicina, Spedali Civili, 25100 Brescia, Italy.
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Rizzoni D, Rosei EA. Small artery remodeling in diabetes mellitus. Nutr Metab Cardiovasc Dis 2009; 19:587-592. [PMID: 19481431 DOI: 10.1016/j.numecd.2009.03.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 02/09/2009] [Accepted: 03/10/2009] [Indexed: 11/29/2022]
Abstract
AIMS To briefly review available data regarding changes in the structure of microvessels observed in patients with diabetes mellitus, and possible correction by effective treatment. DATA SYNTHESIS The development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, small arteries' smooth muscle cells are restructured around a smaller lumen and there is no net growth of the vascular wall, while in some secondary forms of hypertension, hypertrophic remodeling may be detected. Moreover, in non-insulin-dependent diabetes mellitus hypertrophic remodeling of subcutaneous small arteries is present. Indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive and diabetic patients, over and above all other known cardiovascular risk factors. Therefore, regression of vascular alterations is an appealing goal of antihypertensive treatment. Different antihypertensive drugs seem to have different effects on vascular structure. In diabetic hypertensive patients, a significant regression of structural alterations to the small resistance arteries with drugs blocking the renin-angiotensin system (ACE inhibitors, angiotensin II receptor blockers) was demonstrated. CONCLUSION Alterations in the microcirculation represent a common pathological finding, and microangiopathy is one of the most important mechanisms involved in the development of organ damage as well as of clinical events in patients with diabetes mellitus. Renin-angiotensin system blockade seems to be effective in preventing and/or regressing alterations in the microvascular structure.
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Affiliation(s)
- D Rizzoni
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Italy.
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Feihl F, Liaudet L, Waeber B. The macrocirculation and microcirculation of hypertension. Curr Hypertens Rep 2009; 11:182-9. [PMID: 19442327 DOI: 10.1007/s11906-009-0033-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Changes in vascular structure that accompany hypertension may contribute to hypertensive end-organ damage. Both the macrovascular and microvascular levels should be considered, as interactions between them are believed to be critically important. Regarding the macrocirculation, the article first reviews basic concepts of vascular biomechanics, such as arterial compliance, arterial distensibility, and stress-strain relationships of arterial wall material, and then reviews how hypertension affects the properties of conduit arteries, particularly examining evidence that it accelerates the progressive stiffening that normally occurs with advancing age. High arterial stiffness may increase central systolic and pulse pressure by two different mechanisms: 1) Abnormally high pulse wave velocity may cause pressure waves reflected in the periphery to reach the central aorta in systole, thus augmenting systolic pressure; 2) In the elderly, the interaction of the forward pressure wave with high arterial stiffness is mostly responsible for abnormally high pulse pressure. At the microvascular level, hypertensive disease is characterized by inward eutrophic or hypertrophic arteriolar remodeling and capillary rarefaction. These abnormalities may depend in part on the abnormal transmission of highly pulsatile blood pressure into microvascular networks, especially in highly perfused organs with low vascular resistance, such as the kidney, heart, and brain, where it contributes to hypertensive end-organ damage.
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Affiliation(s)
- François Feihl
- Division de Physiopathologie Clinique, MP-14/204, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland
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