Polymorphonuclear leukocytes induced vasoconstriction in isolated canine coronary arteries

A practical and effective approach for the prevention of ischemia-reperfusion injury after acute myocardial infarction: pressure-regulated tepid blood reperfusion

BACKGROUND

The prevention of perioperative ischemia-reperfusion injury is of critical importance, and this issue becomes more important in patients undergoing an early emergent revascularization procedure after an acute myocardial infarction. In this study, we sought to test the hypothesis that our simplified pressure-controlled initial reperfusion technique would be protective against ischemia-reperfusion injury in this subgroup of patients.

METHODS

The data of 20 patients (group I) who underwent an emergent coronary artery bypass grafting procedure were analyzed and compared with the results of 37 patients (group II) underwent an innovative reperfusion technique. In group I patients, the operation was carried out using standard techniques. In group II, after the completion of all anastomoses, reperfusion was initiated before rewarming with a pressure of 20 to 25 mmHg and continued for a 2-minute period. Systemic blood pressure was then gradually increased to 40 mmHg and the aortic root was perfused at this pressure for another 2-minute period. Following the completion of the second low-pressure reperfusion period, cardiopulmonary bypass flow was regulated to preoperatively calculated values until systemic temperature reached 37 degrees C.

RESULTS

Both groups showed significant differences in terms of cardiac output, arrhythmia rates, and biochemical parameters. Spontaneous sinus rhythm recurred more frequently in group II (P < .01, 86% versus 45%). Atrial fibrillation attacks were observed in 5 and 3 patients in groups I and II, respectively. All patients were medically converted to sinus rhythm with amiadarone and/or beta-blockers. Persistent electrocardiographic changes indicating postoperative myocardial infarction occurred in 5 patients in group I and in 1 patient in group II (P = .003). Postoperative enzyme levels were found to be lower in group II patients and the differences became statistically significant at the end of 24 hours.

CONCLUSION

These results indicate that our controlled initial reperfusion technique is effective in the prevention of ischemia-reperfusion injury. We advocate the use of this innovative technique as an alternative to complex controlled aortic root reperfusion with the guidance of the early promising results of this study.

Estrogen therapy and thrombotic risk

Post-menopausal hormone therapy increases the risk for venous thrombosis, and possibly myocardial infarction (MI) and ischemic stroke. However, most women using hormone therapy do not suffer thrombosis, and to date our ability to identify women at risk is limited. Thrombosis, arterial or venous, has 2 requisites: a vascular anomaly and a response of the hemostasis system to the anomaly. Consequently, experimental approaches to understand the pathophysiology of thrombosis require definition of vascular anatomy and function as well as characteristics of the blood within the context of genetic background, lifestyle choices and environmental exposures, which influence gene expression. Defining interactions among factors that affect individual propensity to thrombosis will allow physicians to better identify at-risk individuals, for example a woman contemplating estrogen therapy for symptoms of menopause, and prevent adverse thrombotic events.

Keishi-bukuryo-gan preserves the endothelium dependent relaxation of thoracic aorta in cholesterol-fed rabbit by limiting superoxide generation

Formerly, we have reported that keishi-bukuryo-gan prevents the progression of atherosclerosis in cholesterol-fed rabbits and inhibits the free radical-induced RBC haemolysis in rats. The present study was performed to investigate how keishi-bukuryo-gan (KBG) inhibits the early stage of atherosclerosis. Plasma lipid concentration and hydroxyl radical generation during respiratory burst in neutrophils were evaluated at the start and end of the study. The protective effect of KBG against endothelium disorder due to hypercholesterolaemia was examined. Twelve male Japanese white rabbits (2 kg body weight) were divided into two groups. Group A (n = 6) was fed standard rabbit chow containing 1% cholesterol for 4 weeks. Group B (n = 6) was fed standard rabbit chow containing 1% cholesterol and 1% KBG for 4 weeks. In the plasma lipid concentration, only the lipid peroxide concentration of group A was significantly higher than that of group B. At the end of the study, DMPO-OH, the spin-trapped adduct of hydroxyl radicals generated by neutrophils, was increased in both groups, and this increase was marked in group B. Endothelium-dependent vasodilatation by acetylcholine increased significantly in group B compared with group A. Thus, KBG protects the vascular endothelium function by its antioxidative effect and by inhibiting the release of free radicals from neutrophils in vivo.

Effects of unstimulated polymorphonuclear neutrophils on porcine distal coronary artery tone

Recently, it has been demonstrated that polymorphonuclear neutrophils (PMNs) affect coronary vascular tone. We have reported that unstimulated PMNs constrict the porcine proximal coronary artery. However, the mechanism(s) of interaction between PMNs and coronary artery and the regional differences in susceptibility of the coronary arterial tree have not been fully explored. We examined changes in the isometric tension of porcine distal coronary arterial rings caused by unstimulated PMNs, in which the levels of superoxide anion detected by the cytochrome C method were slight when unstimulated and significant when stimulated with A23187. Unstimulated PMNs relaxed the distal coronary artery and the effect was suppressed by endothelial denudation, indomethacin and the prostacyclin synthetase inhibitor, tranylcypromine. During vasorelaxation, prostacyclin was produced (n=8, with without relaxation; 596 +/- 76/247 +/- 26 pg/ml, p < 0.01) and was considered, therefore, to be the vasodilatory substance responsible for the action. These results suggest that PMNs modulate coronary arterial tone via an interaction between PMNs and endothelium and the release of vasodilating prostaglandins, of which prostacyclin is considered to be one of the substances responsible. Further, the effect differed markedly depending on the site of the coronary artery. In vivo, coronary artery tone is complexly regulated, therefore, the relative contribution of the present PMN-endothelial cell interaction observed in vitro is unclear.

Rabbit polymorphonuclear leukocytes release a factor that causes constriction of the coronary vasculature

Polymorphonuclear leukocytes (PMN) have been shown to have numerous vasoactive effects, particularly in large artery bioassays. This study shows that rabbit PMN passively release a contractile factor that constricts the coronary vasculature of isolated, Langendorff-perfused rabbit hearts. The mechanism of action of this factor does not involve inhibition of nitric oxide (NO), production of cyclooxygenase metabolites, 5-hydroxytryptamine, or endothelin, or the activation of alpha-adrenoceptors but is a Ca2+-dependent process, because the constriction is inhibited by the Ca2+-channel blocker amlodipine. The activity of this factor is significantly inhibited if it is pretreated with trypsin or heated to 90 degreesC for 10 min, and the active factor is concentrated in the retentate of 100-kDa cutoff centrifuge filters, indicating that the factor is a protein >100 kDa in size. This study shows that rabbit PMN spontaneously release a protein factor that causes constriction of isolated, perfused rabbit hearts by a NO-independent but Ca2+-dependent mechanism.

Reduction in infarct size by chronic amlodipine treatment in cholesterol-fed rabbits

Calcium (Ca)-dependent factors, including cholesterol-induced changes in membrane Ca permeability and Ca deposition into lesions, may contribute to plaque formation and stability during the early and late stages of atherogenesis. Amlodipine can reduce atheroma formation in cholesterol-fed rabbits and may be cardioprotective. We therefore examined the effects of chronic amlodipine treatment (5 mg/kg daily for 10 weeks, p.o.) on infarct size after 30-min coronary occlusion/48-h reperfusion in rabbits fed a diet with or without 1% cholesterol. Infarct size was significantly larger in cholesterol-fed rabbits (72.0 +/- 3.5%, n = 9, mean +/- S.E.M.) than in normal-fed rabbits (47.1 +/- 4.9%, n = 9, P < 0.05). Amlodipine treatment effectively reversed the infarct size augmentation in cholesterol-fed rabbits (46.3 +/- 6.3%, n = 9, P < 0.05), but did not affect infarct size in normal-fed rabbits (51.0 +/- 4.7%, n = 8). In both cholesterol-fed and normal-fed rabbits, Ca content and leukocyte accumulation as assessed by myeloperoxidase activity were significantly higher in the ischemic myocardium than in the nonischemic myocardium. However, Ca content and leukocyte accumulation were markedly elevated in the ischemic myocardium of cholesterol-fed rabbits compared with normal-fed rabbits. Amlodipine treatment effectively reversed this elevation. Acetylcholine showed a marked reduction in endothelium-dependent relaxation in the aorta of cholesterol-fed rabbits, which also was reversed by amlodipine treatment. These results indicate that chronic amlodipine treatment reduces infarct size only in cholesterol-fed rabbits.

Role of nitric oxide and free radicals in the contractile response to non-preactivated leukocytes

Previous studies from our laboratory have shown that nitric oxide (NO) can reduce the release of free radicals from activated leukocytes. The aim of this study was to assess the role of endothelium-derived nitric oxide and leukocyte-derived free radicals in the contractile response to non-preactivated leukocytes. Vessel tension studies were performed in rabbit endothelium-intact aortic vessel rings precontracted with 5-hydroxytryptamine (1 microM). Addition of leukocytes isolated from rabbit blood were added to the rings in increasing concentrations (10(3)-10(6) cell ml(-1)) under control conditions and in the presence of L-nitroarginine methyl ester (L-NAME 1 mM), D-NAME (1 mM), or superoxide dismutase (100 U ml(-1)). The responses to superoxide radical (generated by xanthine plus xanthine oxidase, X/XO), hydrogen peroxide, hypochlorite and peroxynitrite were also assessed. The nature of the free radicals released from non-activated isolated leukocytes, zymosan-stimulated leukocytes (in whole blood) and isolated vessel rings was assessed using luminol-enhanced chemiluminescence. Cumulative addition of leukocyte suspensions to aortic rings caused a concentration-dependent contractile response which was abolished by preincubation of the vessel ring with L-NAME. D-NAME and superoxide dismutase were without effect. All the free radicals tested produced a relaxation of the precontracted aortic ring. The response to X/XO was not affected by superoxide dismutase, but abolished by catalase. The responses to hydrogen peroxide and hypochlorite were both found to be dependent upon the presence of endothelium and NO. The response to peroxynitrite was endothelium-independent and was blocked by methylene blue. While the main free radical released from unstimulated leukocytes and vessel rings was superoxide, the main radical released from activated leukocytes was found to be hypochlorite. These results suggest that the vascular contraction seen in response to non-preactivated leukocytes is due to inhibition, by NO, of the release of free radicals from the leukocytes when activated by contact with the vascular endothelium, thus allowing co-released vasoconstrictor substances to exert their effect.

Endogenous nitric oxide release modulates mural platelet thrombosis and neutrophil-endothelium interactions under low and high shear conditions

Nitric oxide (NO) plays an important role in the maintenance of a constant vasodilator tone in the vasculature and confers anti-adhesive properties to the normal functioning endothelium. Whether endogenous NO release influences platelet thrombus formation and neutrophil-endothelium interactions under arterial blood flow conditions was investigated in ex vivo bioassay experiments using superfusion flow chambers. Surfaces of intact or deeply injured porcine arterial segments were exposed to flowing porcine arterial blood under shear conditions typical to patent (424 sec-1) and stenosed (3397 sec-1) arteries, at baseline and after administration of the specific inhibitor of NO synthesis N omega-nitro-L-arginine methyl ester (L-NAME, 3 mg/kg + 3 mg/kg/h; i.v.). L-NAME induced a rapid and significant rise in arterial blood pressure, with a moderate reduction in heart rate. 51Cr platelet deposition on the exposed arterial media, which averaged 15.9 +/- 2.9 x 10(6)/cm2 at a shear rate of 424 sec-1, was increased by L-NAME, to 20.4 +/- 2.8 x 10(6)/cm2 (p < 0.05). At 3397 sec-1 of shear rate, platelet deposition was higher (71.4 +/- 11.9 x 10(6)/cm2) (p < 0.001), and was enhanced by 34%, to 95.8 +/- 12.5 x 10(6)/cm2 (p < 0.05), after L-NAME treatment. 111In neutrophil adhesion to the vascular endothelium was also increased by L-NAME by 83%, from 10.6 +/- 2.5 to 19.4 +/- 5.7 x 10(3)/cm2 (p < 0.05) at 424 sec-1, and by 110%, from 14.1 +/- 4.3 to 29.7 +/- 10.0 x 10(3)/cm2 (p < 0.05) at 3397 sec-1 of shear rate. These results suggest that endogenous NO may be an important modulator of thrombotic and inflammatory processes in patent as well as in stenosed arteries.

Unstimulated polymorphonuclear neutrophils regulate proximal coronary arterial tone

Our objective is to clarify, by measuring the superoxide production as a marker of inactive state of polymorphonuclear neutrophils, whether unstimulated polymorphonuclear neutrophils would influence coronary arterial tone. We recorded the isometric tension of the porcine coronary arterial ring in a bath of oxygenated Krebs Ringer solution. Unstimulated porcine polymorphonuclear neutrophils that contained little superoxide were added to the bath. We also analyzed the prostaglandins produced in the bath. The isometric tension of arterial rings increased dose-dependently when polymorphonuclear neutrophils were added to the bath. The vasoconstriction induced by unstimulated polymorphonuclear neutrophils was inhibited by endothelial denudation, indomethacin, anti-CD11a/18-like antibody. Thromboxane A2 synthetase inhibitor and superoxide dismutase did not effect the vasoconstriction. Prostaglandin E2 predominated among the prostaglandins produced in the bath; its production was significantly inhibited by indomethacin (without vs. with indomethacin; 3898 +/- 1704 vs 1956 +/- 715 pg/ml, P < 0.05, n=6). Pretreatment of vascular rings with indomethacin blocked the interaction of the coronary artery with polymorphonuclear neutrophils. Results suggested that unstimulated polymorphonuclear neutrophils constrict the proximal coronary artery. Such vasoconstriction may be produced by cyclooxygenase products, especially prostaglandin E2 produced in the vascular wall via the interaction between the polymorphonuclear neutrophils and the endothelium. Polymorphonuclear neutrophils may regulate coronary arterial tone.

Inhibition of 5-lipoxygenase-activating protein (FLAP) reduces pulmonary vascular reactivity and pulmonary hypertension in hypoxic rats

Chronically elevated shear stress and inflammation are important in hypertensive lung vessel remodeling. We postulate that 5-lipoxygenase (5-LO) is a molecular determinant of these processes. Immunohistology localized the 5-LO to macrophages of normal and chronically hypoxic rat lungs and also to vascular endothelial cells in chronically hypoxic lungs only. In situ hybridization of normal and chronically hypoxic lungs demonstrated that 5-LO mRNA is expressed in macrophages. Rats hypoxic for 4 wk-developed pulmonary hypertension increased translocation of the lung 5-LO from the cytosol to the membrane fraction and increased levels of lung tissue 5-lipoxygenase-activating protein (FLAP). A FLAP ligand, 3-[l-(4-chlorobenzyl)-3-t-butyl-thio-t-isopropylindol-2-yl]-2,2- dimethylpropanoic acid (MK-886), inhibited the acute angiotensin II and hypoxia-induced pulmonary vasoconstriction in vitro and the development of chronic hypoxic pulmonary hypertension in rats in vivo. Mice bred with the deletion of the 5-LO enzyme (5-LO knockout) developed less right heart hypertrophy than age-matched 5-LO competent mice. Our results support the hypothesis that the 5-LO is involved in lung vascular tone regulation and in the development of chronic pulmonary hypertension in hypoxic rodent models.

Metabolism of arachidonic acid by canine polymorphonuclear leukocytes synthesis of lipoxygenase and omega-oxidized metabolites

Both polymorphonuclear (PMN) leukocytes and metabolites of arachidonic acid, especially lipoxygenase products, have been reported to contribute to myocardial damage after coronary artery occlusion and reperfusion. While canine models of myocardial ischemia were used in many of these studies, very little is known about arachidonic acid metabolism by canine PMNs. Moreover, it is unclear whether arachidonic acid metabolites released by canine PMNs affect vascular tone. Therefore, we characterized arachidonic acid metabolism by canine PMNs and determined the effect of these metabolites on vascular tone of isolated canine coronary arteries. Suspensions of canine PMNs were incubated with [14C]arachidonic acid and the calcium ionophore A23187. The incubation media was extracted, and the metabolites resolved by HPLC. 20-Hydroxy-leukotriene B4 (LTB4), 12,20-dihydroxyeicosatetraenoic acid (diHETE), LTB4, 12-hydroxyheptadeclatrienoic acid (HHT), and 12-(S)-hydroxyeicosatetraenoic acid (HETE) were isolated, and their structures confirmed by gas chromatography/mass spectrometry. There was also evidence for the formation of 20-HETE, thromboxane B2 (TXB2), 5-HETE, and several isomers of LTB4. None of the arachidonic acid metabolites that were isolated from incubates of canine PMNs augmented vascular tone, but material migrating with 12,20-diHETE relaxed canine coronary arteries. Authentic 12(S),20-diHETE also produced a concentration-related relaxation of canine coronary artery. 12(R), 20-diHETE was inactive. 20-HETE inhibited A23187-induced PMN aggregation. Thus, arachidonic acid is metabolized in canine PMNs through the cyclooxygenase, lipoxygenases and cytochrome P-450 pathways. Whether these metabolites contribute to myocardial injury remains to be determined.

Increase of neutrophil adhesion and vasoconstriction with platelet deposition after deep arterial injury by angioplasty

Physiopathologic events after arterial injury are largely influenced by blood element reactions with the injured surface. To determine acute arterial reactivity to injury, simultaneous chromium 51-labeled platelet deposition and indium 111-labeled neutrophil adhesion were quantified at the site of different degrees of carotid arterial injury by balloon dilatation in 21 normal pigs. The degree of vasoconstriction distally to the dilated areas was also quantified angiographically. Arteries were classified histologically as (1) uninjured with intact endothelium; (2) mildly injured with endothelial desquamation; or (3) deeply injured with lesions extending beyond internal elastic lamina, exposing the media. We found that, compared to mild injury, deep injury was associated with greater platelet deposition (38.2 +/- 5.7 x 10(6)/cm2 vs 7.8 +/- 0.9 x 10(6)/cm2; p < 0.05), neutrophil adhesion (30.6 +/- 4.1 x 10(4)/cm2 vs 10.2 +/- 2.9 x 10(4)/cm2; p < 0.05), and vasoconstrictive response (45.5% +/- 3.2% vs 26.7% +/- 2.8%; p < 0.05). Although distally to both types of injuries, noninjured arterial segments with intact endothelium were thromboresistant to platelet deposition, neutrophil adhesion to intact endothelium was much higher after deep injury (2.2 +/- 0.4 x 10(4)/cm2) compared to mild injury (0.36 +/- 0.1 x 10(4)/cm2; p < 0.05). Like platelet deposition, neutrophil adhesion is influenced by the severity of arterial injury; both may therefore be implicated in thrombogenesis and vascular responsiveness after arterial injury in vivo.

Polymorphonuclear leukocytes-induced injury in hypoxic cardiac myocytes

Growing evidence suggests that free radicals derived from polymorphonuclear leukocytes (PMNs) play an important role in myocardial ischemia-reperfusion injury. To elucidate the cellular mechanism by which activated PMNs exacerbate ischemic myocardial damage, we investigated the extent of cell injury, assessed by the morphological deterioration, free radical generation, and lipid peroxidation in mouse embryo myocardial cells coincubated with activated PMNs. The generation of PMN-derived free radicals was related to the extent of myocardial cell injury. When myocardial cell sheets were subjected to hypoxia and glucose-free media, myocardial cells were injured (cristalysis in the mitochondria and disruption of the sarcolemma) after adding various PMN activators, and the injury extended to the adjacent cells. Chemiluminescent emission and production of thiobarbituric acid-reactive substances in the coincubated cells increased markedly compared with myocardial cells or PMNs alone. The augmented lipid peroxidation coincided with the progression of myocardial cell injury. Catalase inhibited the myocardial cell injury by 52%, the chemiluminescence by 46%, and lipid peroxidation by 50%, whereas superoxide dismutase exhibited less pronounced inhibition. These results indicate that a chain reaction of lipid peroxidation in myocardial cells induced by PMN-derived free radicals closely correlates with membrane damage and contributes to the propagation of irreversible myocardial cell damage.

Modulation of neutrophil activity by nitric oxide during acute myocardial ischaemia and reperfusion

Nitric oxide (NO) exerts an inhibitory effect on polymorphonuclear neutrophil (PMN) function, via a cyclic GMP-mediated mechanism, while PMNs are known to play an important role in myocardial ischaemia-reperfusion injury (MI-R). Since the major source of NO, vascular endothelium, becomes functionally impaired during MI-R, it is attractive to hypothesize that it is this loss of endothelial nitric oxide production that allows PMN adherence and activation. The studies reviewed here add substance to this hypothesis. Authentic NO, administered during MI-R both reduces myocardial necrosis and PMN accumulation, while basal NO release, as estimated by coronary artery ring responses to L-NAME, an NO synthase inhibitor, declines during reperfusion with a time-course mirrored by PMN adherence in the same preparation. Reduction in infarct size and decreased PMN accumulation can also be demonstrated with L-arginine and NO donors. Since endothelial dysfunction leads to PMN adherence and PMNs have been shown to contribute to endothelial dysfunction, it seems probable that a positive feedback loop is generated during MI-R, leading to the amplification of PMN activity and subsequent myocardial damage.

Role of platelets and leukocytes in modulation of vascular tone

Activated platelets and leukocytes release potent vasoactive factors that may modulate vascular tone. Activation of normal platelets produces dilatation of normal arteries. Vasodilatation is mediated by adenosine diphosphate (ADP), which releases endothelium-derived relaxing factor (EDRF) from endothelium. In atherosclerotic arteries, activation of platelets produces constriction and perhaps spasm. The constrictor response of atherosclerotic arteries is related in part to profound changes in vascular function: endothelial dysfunction with impaired endothelium-dependent vasodilator responses to ADP, and augmented vasoconstrictor responses to serotonin. In addition, hypercholesterolemia has a direct effect on platelets, resulting in impaired vasodilator responses. Thus, abnormal platelets and altered vascular function may both predispose to spasm of atherosclerotic arteries. Activation of leukocytes has little effect on resistance of large arteries in normal monkeys. In contrast, activation of leukocytes produces pronounced vasoconstriction in atherosclerotic monkeys. Possible mediators of vasoconstriction include prostaglandin E2, oxygen radicals, thromboxane, and a peptide (perhaps angiotensin II). In addition, leukocytes also alter vascular responses to platelets, in part by ADPase on the leukocyte membrane, which degrades ADP released by activated platelets. Leukocytes also release oxygen radicals, which may inactivate EDRF, thereby impairing ADP-mediated, endothelium-dependent vasodilator responses. Abnormal responses to platelets and leukocytes are largely reversed when atherosclerotic lesions regress in monkeys.

Vasoconstrictor responses to polymorphonuclear leucocytes from atherosclerotic rabbits

1. The vascular contractile effects of polymorphonuclear leucocytes (PMN) isolated from control rabbits and from rabbits made atherosclerotic by 1% cholesterol feeding for 8 weeks were examined. 2. Rings of control rabbit thoracic aorta with or without endothelium were mounted at 2 g tension in 10 mL organ baths and were submaximally contracted by phenylephrine (0.1 mumol/L). After 30 min incubation at 37 degrees C, the supernatant of PMN (5 x 10(7)/mL, in Tyrode solution containing 0.25% bovine serum albumin) was obtained by centrifugation for addition to the vascular preparation. 3. Control PMN supernatant (443 microL) caused contraction (0.58 +/- 0.15 g, n = 11) of phenylephrine-contracted aortic rings, which was prevented by removal of the endothelium (0.11 +/- 0.07 g, n = 5, P < 0.05). However, the control PMN supernatant had no contractile effect on aortic rings at resting tension (0.00 +/- 0.00 g, n = 8). 4. By comparison, atherosclerotic PMN supernatant (443 microL) caused a significantly greater contraction of the aortic rings (1.41 +/- 0.13 g, n = 9, P < 0.05 vs control PMN supernatant) that was only partly inhibited by removal of the endothelium (0.45 +/- 0.20 g, n = 9, P < 0.05). Moreover, PMN supernatants from four of seven atherosclerotic rabbits contracted aortic rings at resting tension (3.5 +/- 1.4 g, n = 7). 5. These results suggest that the release of a stable vasoconstrictor substance(s) by PMN is enhanced under conditions of atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial ischaemia: what happens to the coronary arteries?

Study of the effects of myocardial ischaemia and reperfusion has largely been confined to the impairment of cardiac contractility. However, emerging recognition of the importance of endothelium-derived vasoactive factors in blood flow regulation has stimulated interest in the effect of pathological states such as ischaemia on coronary vascular function and is discussed in this review by Christopher Sobey and Owen Woodman. Neutrophils may play a key role in impaired reperfusion and endothelial damage, and pharmacological intervention to preserve endothelial function could significantly improve coronary blood flow and cardiac function after an ischaemic attack.

Acetylcholine-induced relaxation in bovine isolated mesenteric arteries is suppressed by polymorphonuclear leukocytes

1. The endothelium plays a critical role in maintaining vascular tone via generation of potent vasoconstrictor and dilator substances. We examined the effect of bovine purified polymorphonuclear leukocytes (PMN) on the endothelium-dependent relaxation to acetylcholine in isolated mesenteric arteries. 2. In the presence of PMN (2.5 x 10(6) cells ml-1) the maximal relaxation to acetylcholine was decreased from 76.1 +/- 2.4% to 44.9 +/- 7.4% of the precontraction (P < 0.001). This effect was inhibited by superoxide dismutase and NG-mono-methyl-L-arginine, but not by catalase or indomethacin. 3. PMN were not able to influence significantly the endothelium-independent relaxation to nitroprusside. 4. Removal of PMN after preincubation and prior to precontraction and relaxation did not influence the acetylcholine-induced relaxation, indicating that no irreversible vascular damage had occurred. 5. Superoxide anion production by unstimulated PMN was less than 10% compared to phorbol myristate acetate-activated PMN, measured by chemiluminescence and reduction of ferricytochrome c. 6. We conclude that small amounts of superoxide anions produced by unstimulated PMN contribute to a decrease in relaxation to acetylcholine by interfering with endothelium-derived nitric oxide.

Activated neutrophils alter contractile properties of the pulmonary artery

Activated neutrophils produce a wide array of products (free radicals, arachidonate metabolites, degradative enzymes), cause hemodynamic effects and increased permeability in isolated blood-free perfused lungs, and evoke direct injury to cultured endothelial cells. The aims of this study were to investigate the response of isolated rat pulmonary arterial rings to activated neutrophils, the role of intact endothelium in these responses, and which neutrophil products were responsible for the observed effects. Neutrophils activated with phorbol myristate acetate caused an initial increase in tension and a subsequent decreased recovery contraction to KCl. Neutrophils activated with formylmethionylleucylphenylalanine also caused an increase in tension but did not result in decreased recovery, suggesting different mechanisms for these two effects. The contractile response was dependent on endothelium, whereas the decline in recovery still occurred in the absence of endothelium. Filtrate from activated neutrophils did not cause the contractile response, but recovery was decreased. Neither addition of catalase + superoxide dismutase nor decreased superoxide release due to prior activation of neutrophils altered the initial contraction or the decline in recovery contractile ability, suggesting that oxygen free radical products were not responsible for either effect. The cyclooxygenase inhibitors (ibuprofen and indomethacin), the thromboxane A2 synthetase inhibitor (OKY-046), and pretreatment of the neutrophils with aspirin inhibited the contractile response but did not prevent the decrease in recovery. A mixture of antiproteases did not protect the arterial muscle from the decline in recovery. Although cyclooxygenase products may be involved in initiating the contraction in response to activated neutrophils, the mechanism resulting in subsequent loss of force-developing ability is unclear.

Impaired endothelium-dependent relaxation of dog coronary arteries after myocardial ischaemia and reperfusion: prevention by amlodipine, propranolol and allopurinol

1. Anaesthetized, open-chest dogs were subjected to 60 min of left circumflex coronary artery occlusion followed by 90 min of reperfusion. Endothelium-dependent and -independent relaxant responses of the isolated coronary arterial rings were then investigated. 2. The endothelium-dependent, acetylcholine-induced relaxation of ischaemic/reperfused arterial rings was significantly attenuated in comparison to control rings (1.9 fold rightward shift, ischaemic/reperfused maximum relaxation = 57 +/- 13% of control maximum relaxation; P less than 0.05). In contrast, glyceryl trinitrate produced similar relaxant responses in control and ischaemic rings. 3. Pretreatment of dogs with either amlodipine (3 micrograms kg-1 min-1, i.v.) or propranolol (1 mg kg-1, i.v.) completely prevented the postischaemic impairment of endothelium-dependent relaxant responses (100 +/- 3% and 90 +/- 5% of control maximum relaxation, respectively). 4. Allopurinol pretreatment (25 mg kg-1, p.o. 24 h previously, plus 50 mg kg-1 i.v. 5 min before arterial occlusion) partially protected against endothelial dysfunction by preventing the ischaemia-induced rightward shift of the acetylcholine relaxation curve and increasing the maximum relaxation response (83 +/- 7% of control rings). 5. These results confirm that endothelium-dependent coronary vascular relaxation is impaired by ischaemia and reperfusion, and that the ischaemia-induced impairment is reduced by pretreatment with amlodipine, propranolol or allopurinol.

Bovine polymorphonuclear leukocytes increase sensitivity to noradrenaline in isolated mesenteric arteries

1. The effects of polymorphonuclear leukocytes (PMN) on vascular function to (-)-noradrenaline were examined in vitro. Purified bovine PMN were incubated in siliconized organ baths containing rings of bovine mesenteric arteries, after which a concentration-effect curve in response to (-)-noradrenaline was obtained. 2. PMN-derived products induced a long lasting concentration-dependent contraction of the blood vessels generating 24.4 +/- 6.8% of the maximal tension to (-)-noradrenaline at a cell concentration of 2.5 x 10(6) ml-1. The contractile response was also found in endothelium-denuded vascular rings. 3. PMN present in the organ bath caused an increase in the sensitivity of vascular rings to (-)-noradrenaline. At a cell number of 2.5 x 10(6) PMN ml-1 the pD2-value for (-)-noradrenaline was augmented 0.40 +/- 0.05 (P less than 0.001), while total contraction at the highest concentration (-)-noradrenaline was not affected. This increase in sensitivity was dependent on an intact endothelium. 4. The increase in sensitivity to (-)-noradrenaline by PMN was inhibited by superoxide dismutase, but not by catalase, dimethylthiourea, indomethacin or nordihydroguaiaretic acid. The non-stimulated bovine PMN produced oxygen radicals as measured by chemiluminescence. 5. Simultaneous incubation of PMN and (-)-noradrenaline with arterial rings induced an increase in the release of prostacyclin, measured by an elevated concentration of 6-keto-prostaglandin F1 alpha in the supernatant. 6. It is concluded that PMN can increase vascular tone directly or indirectly probably via the interaction of PMN-derived superoxide anions with endothelium-derived relaxing factor.

Activated neutrophils impair rabbit heart recovery after hypothermic global ischemia

Cardiopulmonary bypass is known to cause neutrophil activation, and activated neutrophils appear to be of importance in myocardial reperfusion injury. This study examined the effect of a preischemic infusion of activated neutrophils on the recovery of myocardial function after 40 minutes of hypothermic global ischemia. Studies were carried out in three groups of Langendorff-perfused rabbit hearts: control, control (unactivated) neutrophil infusion, and phorbol myristate acetate-activated neutrophil infusion. The activated neutrophil group showed significant deterioration in function during the activated neutrophil infusion. All three groups demonstrated significant depression of function initially after reperfusion, but the two control groups subsequently recovered to baseline levels. The activated neutrophil group, however, showed a persistent significant depression in ventricular force, rate of ventricular tension development, and rate of ventricular relaxation as well as a significant increase in coronary vascular resistance. It is concluded that activated neutrophils depress myocardial function and contribute to impaired recovery of function after global hypothermic ischemia.

Proclivity of activated neutrophils to cause postischemic cardiac dysfunction: participation in stunning?

Myocardial stunning is a reversible defect in contractile function provoked by brief episodes of ischemia followed by reperfusion. Many studies have demonstrated the potential involvement of free radicals in the etiology of myocardial stunning. While activated neutrophils have the capacity to release free radicals and evoke contractile dysfunction, it is not clear that this potential is realized in the absence of myocellular damage. Attempts to define the contribution of activated neutrophils to myocardial stunning by removing the cells from the bloodstream are contradictory, and the apparent simplicity of this seemingly logical approach is an illusion. For example, it is not known how many neutrophils are required to induce contractile failure, the site of action within the heart, the mechanisms that may be responsible, or even the time course or process of neutrophil activation. The production of free radicals and endothelial dysfunction may create conditions propitious for neutrophil recruitment. However, because activated neutrophils synthesize and release various mediators that are potentially toxic to myocardium, once the stage is reached for leukocyte accumulation, it may herald the progression from reversible to irreversible cardiac injury.

Cytokine stimulated endothelin release from endothelial cells

Endothelin release from bovine endothelial cells of the aorta, pulmonary artery, and retinal microvessels was measured in response to various cytokines. Transforming growth factor beta (0.05-5 ng/ml) was found to be a potent stimulator (3-4 fold increase) of endothelin secretion in all three cell types. Tumour necrosis factor alpha (0.1-10 ng/ml) and interferon gamma (8-800 U/ml) had a small (1.5-2 fold increase) but significant effect on endothelin secretion from endothelial cells of large vessels but not the retinal microvessels. Interleukin-1 beta, Interleukin-6 and interleukin-8 at various doses did not affect endothelin secretion. These effects were observed at various time points from 6-24 hrs and indicate that of the cytokines tested, only transforming growth factor beta has a potent effect on endothelin release from endothelial cells of different organs.