Effects of elevated glucose concentrations on the metabolism of the aortic wall

The role of oxygen transport in atherosclerosis and vascular disease

Atherosclerosis and vascular disease of larger arteries are often associated with hypoxia within the layers of the vascular wall. In this review, we begin with a brief overview of the molecular changes in vascular cells associated with hypoxia and then emphasize the transport mechanisms that bring oxygen to cells within the vascular wall. We focus on fluid mechanical factors that control oxygen transport from lumenal blood flow to the intima and inner media layers of the artery, and solid mechanical factors that influence oxygen transport to the adventitia and outer media via the wall's microvascular system-the vasa vasorum (VV). Many cardiovascular risk factors are associated with VV compression that reduces VV perfusion and oxygenation. Dysfunctional VV neovascularization in response to hypoxia contributes to plaque inflammation and growth. Disturbed blood flow in vascular bifurcations and curvatures leads to reduced oxygen transport from blood to the inner layers of the wall and contributes to the development of atherosclerotic plaques in these regions. Recent studies have shown that hypoxia-inducible factor-1α (HIF-1α), a critical transcription factor associated with hypoxia, is also activated in disturbed flow by a mechanism that is independent of hypoxia. A final section of the review emphasizes hypoxia in vascular stenting that is used to enlarge vessels occluded by plaques. Stenting can compress the VV leading to hypoxia and associated intimal hyperplasia. To enhance oxygen transport during stenting, new stent designs with helical centrelines have been developed to increase blood phase oxygen transport rates and reduce intimal hyperplasia. Further study of the mechanisms controlling hypoxia in the artery wall may contribute to the development of therapeutic strategies for vascular diseases.

Chemical Constituents of Smilax china L. Stems and Their Inhibitory Activities against Glycation, Aldose Reductase, α-Glucosidase, and Lipase

The search for natural inhibitors with anti-diabetes properties has gained increasing attention. Among four selected Smilacaceae family plants, Smilax china L. stems (SCS) showed significant in vitro anti-glycation and rat lens aldose reductase inhibitory activities. Bioactivity-guided isolation was performed with SCS and four solvent fractions were obtained, which in turn yielded 10 compounds, including one phenolic acid, three chlorogenic acids, four flavonoids, one stilbene, and one phenylpropanoid glycoside; their structures were elucidated using nuclear magnetic resonance and mass spectrometry. All solvent fractions, isolated compounds, and stem extracts from plants sourced from six different provinces of South Korea were next tested for their inhibitory effects against advanced glycation end products, as well as aldose reductase. α-Glucosidase, and lipase assays were also performed on the fractions and compounds. Since compounds 3, 4, 6, and 8 appeared to be the superior inhibitors among the tested compounds, a comparative study was performed via high-performance liquid chromatography with photodiode array detection using a self-developed analysis method to confirm the relationship between the quantity and bioactivity of the compounds in each extract. The findings of this study demonstrate the potent therapeutic efficacy of SCS and its potential use as a cost-effective natural alternative medicine against type 2 diabetes and its complications.

Dual effects of fructose on ChREBP and FoxO1/3α are responsible for AldoB up-regulation and vascular remodelling

Increased production of methylglyoxal (MG) in vascular tissues is one of the causative factors for vascular remodelling in different subtypes of metabolic syndrome, including hypertension and insulin resistance. Fructose-induced up-regulation of aldolase B (AldoB) contributes to increased vascular MG production but the underlying mechanisms are unclear. Serum levels of MG and fructose were determined in diabetic patients with hypertension. MG level had significant positive correlations with blood pressure and fructose level respectively. C57BL/6 mice were fed with control or fructose-enriched diet for 3 months and ultrasonographic and histologic analyses were performed to evaluate arterial structural changes. Fructose-fed mice exhibited hypertension and high levels of serum MG with normal glucose level. Fructose intake increased blood vessel wall thickness and vascular smooth muscle cell (VSMC) proliferation. Western blotting and real-time PCR analysis revealed that AldoB level was significantly increased in both the aorta of fructose-fed mice and the fructose-treated VSMCs, whereas aldolase A (AldoA) expression was not changed. The knockdown of AldoB expression prevented fructose-induced MG overproduction and VSMC proliferation. Moreover, fructose significantly increased carbohydrate-responsive element-binding protein (ChREBP), phosphorylated FoxO1/3α and Akt1 levels. Fructose induced translocation of ChREBP from the cytosol to nucleus and activated AldoB gene expression, which was inhibited by the knockdown of ChREBP. Meanwhile, fructose caused FoxO1/3α shuttling from the nucleus to cytosol and inhibited its binding to AldoB promoter region. Fructose-induced AldoB up-regulation was suppressed by Akt1 inhibitor but enhanced by FoxO1/3α siRNA. Collectively, fructose activates ChREBP and inactivates FoxO1/3α pathways to up-regulate AldoB expression and MG production, leading to vascular remodelling.

Effects of factor Xa on the expression of proteins in femoral arteries from type 2 diabetic patients

AIM

Further to its pivotal role in haemostasis, factor Xa (FXa) promotes effects on the vascular wall. The purpose of the study was to evaluate if FXa modifies the expression level of energy metabolism and oxidative stress-related proteins in femoral arteries obtained from type 2 diabetic patients with end-stage vasculopathy.

METHODS

Femoral arteries were obtained from 12 type 2 diabetic patients who underwent leg amputation. Segments from the femoral arteries were incubated in vitro alone and in the presence of 25 nmol l(-1) FXa and 25 nmol l(-1) FXa + 50 nmol l(-1) rivaroxaban.

RESULTS

In the femoral arteries, FXa increased triosephosphate isomerase and glyceraldehyde-3-phosphate dehydrogenase isotype 1 expression but decreased pyruvate dehydrogenase expression. These facts were accompanied by an increased content of acetyl-CoA. Aconitase activity was reduced in FXa-incubated femoral arteries as compared with control. Moreover, FXa increased the protein expression level of oxidative stress-related proteins which was accompanied by an increased malonyldialdehyde arterial content. The FXa inhibitor, rivaroxaban, failed to prevent the reduced expression of pyruvate dehydrogenase induced by FXa but reduced acetyl-CoA content and reverted the decreased aconitase activity observed with FXa alone. Rivaroxaban + FXa but not FXa alone increased the expression level of carnitine palmitoyltransferase I and II, two mitochondrial long chain fatty acid transporters. Rivaroxaban also prevented the increased expression of oxidative stress-related proteins induced by FXa alone.

CONCLUSIONS

In femoral isolated arteries from type 2 diabetic patients with end-stage vasculopathy, FXa promoted disruption of the aerobic mitochondrial metabolism. Rivaroxaban prevented such effects and even seemed to favour long chain fatty acid transport into mitochondria.

Phenolic Compounds from the Leaves and Twigs of Osteomeles schwerinae That Inhibit Rat Lens Aldose Reductase and Vessel Dilation in Zebrafish Larvae

Three new phenolic biphenyl derivatives (1-3) and one new lignan glycoside (4) were isolated from the leaves and twigs of Osteomeles schwerinae. The structures of the new compounds were established by spectroscopic data interpretation. The inhibitory effects of 1-4 on rat lens aldose reductase in vitro were examined, and compounds 1-3 markedly inhibited the enzyme with IC50 values of 3.8 to 13.8 μM. In addition, the effects of these isolates on the dilation of hyaloid-retinal vessels induced by high glucose (HG) in zebrafish larvae were investigated. Compound 1 was the most effective in reducing HG-induced dilation of hyaloid-retinal vessels.

Synthesis and biological evaluation of new piplartine analogues as potent aldose reductase inhibitors (ARIs)

As a continuation of our efforts directed towards the development of anti-diabetic agents from natural sources, piplartine was isolated from Piper chaba, and was found to inhibit recombinant human ALR2 with an IC(50) of 160 μM. To improve the efficacy, a series of analogues have been synthesized by modification of the styryl/aromatic and heterocyclic ring functionalities of this natural product lead. All the derivatives were tested for their ALR2 inhibitory activity, and results indicated that adducts 3c, 3e and 2j prepared by the Michael addition of piplartine with indole derivatives displayed potent ARI activity, while the other compounds displayed varying degrees of inhibition. The active compounds were also capable of preventing sorbitol accumulation in human red blood cells.

Inhibition of aldose reductase by Gentiana lutea extracts

Accumulation of intracellular sorbitol due to increased aldose reductase (ALR2) activity has been implicated in the development of various secondary complications of diabetes. Thus, ALR2 inhibition could be an effective strategy in the prevention or delay of certain diabetic complications. Gentiana lutea grows naturally in the central and southern areas of Europe. Its roots are commonly consumed as a beverage in some European countries and are also known to have medicinal properties. The water, ethanol, methanol, and ether extracts of the roots of G. lutea were subjected to in vitro bioassay to evaluate their inhibitory activity on the ALR2. While the ether and methanol extracts showed greater inhibitory activities against both rat lens and human ALR2, the water and ethanol extracts showed moderate inhibitory activities. Moreover, the ether and methanol extracts of G. lutea roots significantly and dose-dependently inhibited sorbitol accumulation in human erythrocytes under high glucose conditions. Molecular docking studies with the constituents commonly present in the roots of G. lutea indicate that a secoiridoid glycoside, amarogentin, may be a potential inhibitor of ALR2. This is the first paper that shows G. lutea extracts exhibit inhibitory activity towards ALR2 and these results suggest that Gentiana or its constituents might be useful to prevent or treat diabetic complications.

Diabetic neuropathy: cellular mechanisms as therapeutic targets

In patients with diabetes, nerve injury is a common complication that leads to chronic pain, numbness and substantial loss of quality of life. Good glycemic control can decrease the incidence of diabetic neuropathy, but more than half of all patients with diabetes still develop this complication. There is no approved treatment to prevent or halt diabetic neuropathy, and only symptomatic pain therapies, with variable efficacy, are available. New insights into the mechanisms leading to the development of diabetic neuropathy continue to point to systemic and cellular imbalances in metabolites of glucose and lipids. In the PNS, sensory neurons, Schwann cells and the microvascular endothelium are vulnerable to oxidative and inflammatory stress in the presence of these altered metabolic substrates. This Review discusses the emerging cellular mechanisms that are activated in the diabetic milieu of hyperglycemia, dyslipidemia and impaired insulin signaling. We highlight the pathways to cellular injury, thereby identifying promising therapeutic targets, including mitochondrial function and inflammation.

NAD+/NADH and NADP+/NADPH in cellular functions and cell death: regulation and biological consequences

Accumulating evidence has suggested that NAD (including NAD+ and NADH) and NADP (including NADP+ and NADPH) could belong to the fundamental common mediators of various biological processes, including energy metabolism, mitochondrial functions, calcium homeostasis, antioxidation/generation of oxidative stress, gene expression, immunological functions, aging, and cell death: First, it is established that NAD mediates energy metabolism and mitochondrial functions; second, NADPH is a key component in cellular antioxidation systems; and NADH-dependent reactive oxygen species (ROS) generation from mitochondria and NADPH oxidase-dependent ROS generation are two critical mechanisms of ROS generation; third, cyclic ADP-ribose and several other molecules that are generated from NAD and NADP could mediate calcium homeostasis; fourth, NAD and NADP modulate multiple key factors in cell death, such as mitochondrial permeability transition, energy state, poly(ADP-ribose) polymerase-1, and apoptosis-inducing factor; and fifth, NAD and NADP profoundly affect aging-influencing factors such as oxidative stress and mitochondrial activities, and NAD-dependent sirtuins also mediate the aging process. Moreover, many recent studies have suggested novel paradigms of NAD and NADP metabolism. Future investigation into the metabolism and biological functions of NAD and NADP may expose fundamental properties of life, and suggest new strategies for treating diseases and slowing the aging process.

The dynamic vasa vasorum

The function of vasa vasorum is both to deliver nutrients and oxygen to arterial and venous walls and to remove "waste" products, either produced by cells in the wall or introduced by diffusional transport through the endothelium of the artery or vein. Although the relationship between changes in vasa vasorum characteristics and the development of atheromatous plaques is well documented, the role of vasa vasorum, especially in terms of their appearance and disappearance in disease processes such as atherosclerosis, are still not clearly understood in terms of their being causative or merely reactive. However, even if their proliferation is merely reactive, these new microvessels may be a source of disease progression by virtue of endothelial impairment and as a pathway for monocytic cells to migrate to sites of early disease. As both these features are aspects of the vasa vasorum function, this Review focuses on the following issues: 1) acute modulation of vasa vasorum patency due to surrounding compressive forces within vessel wall and due to variable tone in the smooth muscle within proximal vasa vasorum and 2) chronic angiogenic responses due to local cytokine accumulations such as occur in the wall of arteries in the presence of hypertension, hypercholesterolemia, accumulation of lipids, extravasated blood products (e.g., red blood cells, macrophages, inflammatory products) which attract monocytes, and response of vasa vasorum to pharmacological stimuli.

Pyridine nucleotide redox abnormalities in diabetes

In addition to hyperglycemia, diabetes is associated with increased levels of circulating free fatty acids, lactate, and branched chain amino acids, all of which produce an excessive reduced form of pyridine nucleotides NADH (reductive stress) in the cytosol and mitochondria. Our studies suggest that cytosolic NADH reductive stress under high glucose is largely caused by increased flux of glucose through polyol (sorbitol) pathway consisting of aldose reductase and sorbitol dehydrogenase. Inhibition of aldose reductase that blocks the polyol pathway has been shown to ameliorate diabetic neuropathy in humans. Cytosolic NADH reductive stress is predicted to increase production of diglycerides, reactive oxygen species, and methylglyoxal. Recent studies indicate that increasing NADH affects gene expression through the NADH activating transcriptional co-repressor, C-terminal binding protein (CtBP). In addition, it has been shown that the NADH utilizing enzyme, glyceraldehyde-3-phosphate dehydrogenase, participates as transcriptional regulator. These findings testify to the importance of NADH redox balance in cell biology and pathogenesis of diabetes and its complications. For example, through CtBP, the high NADH to NAD(+) ratio decreases an expression of SirT1, the protein inducing longevity and anti-apoptosis. This review covers metabolic cascades causing reductive stress and oxidative stress in diabetes after a brief introduction of the redox concept.

Osmotic pressure and vasculature of gingiva in experimental diabetes mellitus

BACKGROUND

Alterations in tissue osmotic pressure (OP) and vasculature are considered to be the inevitable aspects of an inflammatory process that subsequently alter the fluid dynamics of the tissues involved. The aim of this study was to reveal a profile of OP and vascular changes in periodontally healthy gingival tissues and analyze the relationship between them in diabetes mellitus (DM) to evaluate the possible effects of DM on the fluid dynamics of the periodontium.

METHODS

Experimental DM was created by intraperitoneal streptozotocin injection in 10 periodontally healthy rats. These rats were used as the test group, and 10 systemically and periodontally healthy rats served as the control group. Gingival tissue samples obtained from the groups were used for the test procedures. OP was measured in the supernatants of these samples by a semimicrodigital osmometer. Vasculature was assessed as the alterations in vascularization (vessel number [VN]) and vasodilatation (vessel diameter [VD]) by histomorphometric means.

RESULTS

There was a gross increase in the OP level of the test group (172.7 +/- 59.7 mOsm/kg) compared to the control group (11.4 +/- 4.2 mOsm/kg; P <0.001). VN was found to be significantly larger in the test group (12.7 +/- 2.8) than in the control group (6.8 +/- 1.1; P <0.001). VD was found to be smaller in the test group (10.1 +/- 2.8 microm) than in the control group (15.5 +/- 2.4 microm), and this difference was statistically significant (P <0.001). A positive correlation between OP and VN (r = 0.77; P <0.001) and a negative correlation between OP and VD (r = 0.1; P >0.05) were observed in the test group.

CONCLUSION

Our results reveal that the fluid dynamics of periodontal soft tissues may be affected by the diabetic conditions in this diabetic model because of the increased OP and VN during the pathogenesis of the disease.

Hypoxia Increases LDL Oxidation and Expression of 15-Lipoxygenase-2 in Human Macrophages

Objective— Macrophage-mediated oxidation of low-density lipoprotein (LDL) by enzymes, such as the lipoxygenases, is considered of major importance for the formation of oxidized LDL during atherogenesis. Macrophages have been identified in hypoxic areas in atherosclerotic plaques.

Methods and Results— To investigate the role of hypoxia in macrophage-mediated LDL oxidation, we incubated human monocyte-derived macrophages with LDL under normoxic (21% O 2 ) or hypoxic (0% O 2 ) conditions. The results showed that hypoxic macrophages oxidized LDL to a significantly higher extent than normoxic cells. Interestingly, the mRNA and protein expression of 15-lipoxygenase-2 (15-LOX-2) as well as the activity of this enzyme are elevated in macrophages incubated at hypoxia. Both the unspliced 15-LOX-2 and the spliced variant 15-LOX-2sv-a are found in macrophages. In addition, 15-LOX-2 was identified in carotid plaques in some macrophage-rich areas but was only expressed at low levels in nondiseased arteries.

Conclusions— In summary, these observations show for the first time that 15-LOX-2 is expressed in hypoxic macrophages and in atherosclerotic plaques and suggest that 15-LOX-2 may be one of the factors involved in macrophage-mediated LDL oxidation at hypoxia.

Converting enzyme inhibitor temocaprilat prevents high glucose-mediated suppression of human aortic endothelial cell proliferation

We examined the involvement of the oxidative stress in high glucose-induced suppression of human aortic endothelial cell proliferation. Chronic glucose treatment for 72 h concentration-dependently (5.6-22.2 mol/l) inhibited human coronary endothelial cell proliferation. Temocaprilat, an angiotensin-converting enzyme inhibitor, at 10 nmol/l to 1 micromol/l inhibited high glucose (22.2 mmol/l)-mediated suppression of human aortic endothelial cell proliferation. Temocaprilat at 1 micromol/l inhibited high glucose-induced membrane-bound protein kinase C activity in human aortic endothelial cells. The protein kinase C inhibitors calphostin C 100 nmol/l or chelerythrine 1 micromol/l inhibited high glucose-mediated suppression of human aortic endothelial cell proliferation. Chronic high glucose treatment for 72 h increased intracellular oxidative stress, directly measured by flow cytometry using carboxydichlorofluorescein diacetate bis-acetoxymethyl ester, and this increase was significantly suppressed by temocaprilat 10 nmol/l to 1 micromol/l. Bradykinin B2 receptor antagonist icatibant 100 nmol/l significantly reduced the action of temocaprilat; whereas bradykinin B1 receptor antagonist des-Arg9-Leu8-bradykinin 100 nmol/l had no effect. These findings suggest that high glucose inhibits human aortic endothelial cell proliferation and that the angiotensin-converting enzyme inhibitor temocaprilat inhibits high glucose-mediated suppression of human aortic endothelial cell proliferation, possibly through suppression of protein kinase C, bradykinin B2 receptors and oxidative stress.

Aldose reductase inhibitor improves insulin-mediated glucose uptake and prevents migration of human coronary artery smooth muscle cells induced by high glucose

We examined involvement of the polyol pathway in high glucose-induced human coronary artery smooth muscle cell (SMC) migration using Boyden's chamber method. Chronic glucose treatment for 72 hours potentiated, in a concentration-dependent manner (5.6 to 22.2 mol/L), platelet-derived growth factor (PDGF) BB-mediated SMC migration. This potentiation was accompanied by an increase in PDGF BB binding, because of an increased number of PDGF-beta receptors, and this potentiation was blocked by the aldose reductase inhibitor epalrestat. Epalrestat at concentrations of 10 and 100 nmol/L inhibited high glucose-potentiated (22.2 mmol/L), PDGF BB-mediated migration. Epalrestat at 100 nmol/L inhibited a high glucose-induced increase in the reduced/oxidized nicotinamide adenine dinucleotide ratio and membrane-bound protein kinase C (PKC) activity in SMCs. PKC inhibitors calphostin C (100 nmol/L) and chelerythrine (1 micromol/L) each inhibited high glucose-induced, PDGF BB-mediated SMC migration. High glucose-induced suppression of insulin-mediated [(3)H]-deoxyglucose uptake, which was blocked by both calphostin C (100 nmol/L) and chelerythrine (1 micromol/L), was decreased by epalrestat (100 nmol/L). Chronic high glucose treatment for 72 hours increased intracellular oxidative stress, which was directly measured by flow cytometry using carboxydichlorofluorescein diacetate bis-acetoxymethyl ester, and this increase was significantly suppressed by epalrestat (100 nmol/L). Antisense oligonucleotide to PKC-beta isoform inhibited high glucose-mediated changes in SMC migration, insulin-mediated [(3)H]-deoxyglucose uptake, and oxidative stress. These findings suggest that high glucose concentrations potentiate SMC migration in coronary artery and that the aldose reductase inhibitor epalrestat inhibits high glucose-potentiated, PDGF BB-induced SMC migration, possibly through suppression of PKC (PKC-beta), impaired insulin-mediated glucose uptake, and oxidative stress.

An aldose reductase inhibitor prevents the glucose-induced increase in PDGF-beta receptor in cultured rat aortic smooth muscle cells

To examine the role of platelet-derived growth factor (PDGF) and the polyol pathway in the growth activity of smooth muscle cells (SMCs), [(3)H]-thymidine incorporation, [(125)I]-PDGF-BB binding and expression of PDGF-beta receptor protein were measured in rat aortic SMCs cultured with 5.5 or 20 mM glucose with or without anti-PDGF antibody or an aldose reductase inhibitor, epalrestat. SMCs cultured with 20 mM glucose demonstrated an accelerated thymidine incorporation compared with SMCs cultured with 5.5 mM glucose, which was prevented by anti-PDGF antibody. This acceleration of growth activity by 20 mM glucose was accompanied by an increase in PDGF-BB binding, which was due to the increased number of PDGF-beta receptors and the overexpression of PDGF-beta receptor protein. Epalrestat prevented all these abnormalities. These observations suggest that polyol pathway hyperactivity plays an important role in the proliferation of SMCs which may be mediated through the accelerated expression of PDGF-beta receptor protein.

Aldose reductase inhibitor prevents hyperproliferation and hypertrophy of cultured rat vascular smooth muscle cells induced by high glucose

Vascular remodeling is a key process in the pathophysiology of atherosclerosis. Recent evidence suggests that high glucose levels may function as a vascular smooth muscle growth and proliferation-promoting substance. To explore the role of the polyol pathway in this process, we examined the effect of an aldose reductase inhibitor (ARI), epalrestat, on the growth characteristics of cultured rat vascular smooth muscle cells (VSMCs). Epalrestat (10 nmol/L, 1 mumol/L) significantly suppressed the high glucose-induced proliferative effect as measured by [3H]thymidine incorporation by 67% and 82% in cell number, suggesting ARI as an antimitogenic factor. In VSMCs, epalrestat (10 nmol/L, 1 mumol/L) significantly suppressed the high glucose-induced incorporation of [3H]leucine by 45% and 58% with the concomitant reduction of the cell size estimated by flowcytometry. Epalrestat (1 mumol/L) also suppressed high glucose-induced intracellular NADH/NAD+ increase and membrane-bound protein kinase C activation. These results indicate that this ARI possesses an antiproliferative and antihypertrophic action on VSMCs induced by high glucose possibly through protein kinase C suppression.

Association of elastin glycation and calcium deposit in diabetic rat aorta

The relationship between glycation of the aortic elastin and calcium deposits in the aorta was studied in streptozocin (STZ)-induced diabetic rats. 5-Hydroxymethylfurfural (5-HMF) which was released from aortic elastin by acid, was assayed after STZ treatment as an index of early stage glycation. The amount of released 5-HMF increased at 5 weeks and paradoxically decreased at 10 weeks after STZ treatment, though it remained higher than that of control rats. This paradoxical pattern was reproduced by the in vitro incubation of elastin with glucose and it is presumably due to further advancement of glycation reactions in diabetic rats. The level of 5-HMF did not change significantly in control rats at corresponding time points of 9, 11 and 16 weeks of age. Fluorescence of porcine pancreatic elastase I-digested elastin which served as an index of advanced glycation, increased by 1.6 times at 3 weeks and reached a maximum of 1.9-fold higher than that of control rats at 10 weeks. The calcium content of the aorta at 10 weeks in diabetic rats was significantly increased by 1.4-fold compared with control rats. This study showed that the increased elastin glycation in the aorta even at the early stage of diabetes is associated with calcium deposit in the aorta. These results are consistent with the interpretation that elastin glycation in the aorta is the potential accelerating factor for diabetic macroangiopathy.

Glucose modulation of aldose reductase mRNA expression and its activity in cultured calf pulmonary artery endothelial cells

We examined the effect of glucose on aldose reductase mRNA expression and its activity in calf pulmonary artery endothelial cells. After the cells were exposed to 18 mmol/l glucose, aldose reductase mRNA expression began to increase at 6 h, reached a maximum (about 2.4-fold increase) at 12 h, and thereafter gradually decreased. Aldose reductase activity was found to strongly correlate with aldose reductase mRNA expression after cells were exposed to 18 mmol/l glucose. In contrast, aldose reductase mRNA expression was significantly decreased following exposure to 55 mmol/l glucose. Aldose reductase activity was also decreased at 24 h after 55 mmol/l glucose. The increase in aldose reductase mRNA level caused by glucose was inhibited by 1 microgram/ml of actinomycin D. These phenomena appear to be glucose-specific since neither 3-O-methylglucose nor fructose affected the levels of aldose reductase mRNA. We clearly demonstrate that aldose reductase mRNA level and its activity are modulated by glucose in calf pulmonary artery endothelial cells. Our data suggest that activation of aldose reductase in endothelial cells may contribute to the development of diabetic macroangiopathy.

Haemodynamics and arterial wall metabolism: their possible combined role in atherogenesis

An integrated model for the genesis of atherosclerosis is proposed on the basis of the evidence reported in the literature from the fields of haemodynamics and arterial wall metabolism. The model is based on the hypothesis of 'localized nutrient shortage' in the arterial wall at critical regions of the vascular tree, such as branchings, bendings, stenosis etc. In particular, it is proposed that a tissue deficit of glucose and oxygen, more pronounced at those regions, may be the main cause of endothelial dysfunction and lesion initiation. LDL-cholesterol level and hypertension are included as strongly interacting risk factors, and new explanations are provided for the effects of smoking and diabetes. For the latter factors, transport limitations in the lumen and/or in the tissue are likely to interact with wall metabolism; in the case of smoking, additional competition of CO and O2 within the tissue is suggested, and for diabetes, the impaired uptake of glucose by the tissue is proposed as the main causal factor. Also, the incorporation of secondary risk factors to the model is shown to be feasible on the basis of their suggested action mechanism. It is concluded that the study of nutrients and LDL transport at regions of complex arterial geometry in connection with wall metabolic requirements can provide a better understanding of the atherogenic process.

Mechanism of glucose-induced (Na+, K+)-ATPase inhibition in aortic wall of rabbits

Hyperglycaemia decreases (Na+, K+)-ATPase activity in specific tissues by a mechanism whose effects are prevented by aldose reductase inhibitors and by raising plasma myo-inositol. This mechanism was activated and studied in vitro in normal rabbit aortic intima-media. Raising medium glucose to 10 mmol/l for 60 min inhibited a major component of (Na+, K+)-ATPase-mediated 86Rb+/K+ uptake normally operative in resting aortic intima-media in medium containing normal plasma levels of glucose (5 mmol/l) and myo-inositol (70 mumol/l); 20 or 30 mmol/l glucose had no greater effect. This effect occurred under conditions in which the aortic intima-media's normal myo-inositol content is not detectably decreased. The inhibition was prevented by sorbinil (10 mumol/l) and by raising medium myo-inositol from 70 to 500 mumol/l, which had no effect on (Na+, K+)-ATPase activity when the medium glucose remained at 5 mmol/l. Raising medium glucose selectively inhibited a component of (Na+, K+)-ATPase activity that requires medium myo-inositol, because it is maintained by a regulatory system through rapid basal phosphatidylinositol turnover in a discrete pool, which is replenished by a fraction of basal de novo phosphatidylinositol synthesis that is selectively dependent on myo-inositol uptake. Medium myo-inositol at a normal plasma level became inadequate to maintain this fraction of basal de novo phosphatidylinositol synthesis [( 1,3-14C]glycerol incorporation) when the medium glucose was raised. When sorbinil was added raising medium glucose did not alter the ability of 70 mumol/l medium myoinositol to maintain the (Na+, K+)-ATPase activity that requires medium myo-inositol.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical manifestations of diabetes mellitus in microscopic layers of the cornea and retina

Biochemical evidence of glucose toxicity was found in the retinal and corneal layers of diabetic rabbits. It can be reasonably assumed that the observed changes are causally related to the morphological and physiological diabetic pathologies of the retinal and corneal cells. Intracellular glucose is greatly increased, and the polyol pathway activity appears to be enhanced, resulting in an accumulation of intracellular sorbitol, which can be assumed to be oxidized to fructose. Accompanying the alterations of glucose metabolism are disturbances in myoinositol and Na+ handling by the affected structures. The detailed relationship of the observed metabolic effects of hyperglycemia to changes in cellular ion handling and the observed morphological and functional disturbances has yet to be elucidated. The morphologically and functionally discrete populations of RPE and CEN cells, which are readily amenable to experimental manipulation in situ and in cell culture may serve as unique models for systematic examination of the causes and the consequences of diabetes leading to ocular complications in particular and to the complications of other more complex tissues such as nerve and kidney. The present data show that the findings in one population of cells may not be completely reproducible in another as can be seen in the diverse myoinositol responses of the retinal and corneal layers to diabetes mellitus. The diverse responses perhaps reflect unique adaptive capabilities of individual tissues to the diabetic condition. It is a challenge for complications research to fully appreciate diverse responses of various tissues to persistent glucose intoxication and to delineate meticulously the time courses of such heterogeneous responses, which might result in debilitating pathology in certain cases but in a compensated chronic disease state in others. The corneal endothelium and the RPE are relatively resilient structures compared with the mural and endothelial cells of the retinal microvessels which are destroyed by the diabetic condition. Factors and components that protect tissues against the persistent effects of hyperglycemia need to be uncovered. Success in such an endeavor could be of benefit in the management of diabetic complications.

The effect of elevated glucose levels on myo-inositol metabolism in cultured bovine aortic endothelial cells

Bovine aorta endothelial cells were used to determine the effect of high ambient glucose concentrations on myo-inositol metabolism. Culturing the cells for a minimum of 1 week in elevated glucose concentrations caused an increase in the intracellular sorbitol content and a decrease in myo-inositol levels. The accumulation of myo-inositol from the medium and incorporation into phospholipids was reduced 25% to 50% in cells grown in the presence of 30 to 50 mmol/L glucose. This effect was not observed following a short-term exposure of the cells to elevated glucose levels. Kinetic analysis of high-affinity myo-inositol uptake showed that the K'm was significantly increased in cells grown in 30 mmol/L glucose compared to those cultured in 5.6 mmol/L glucose. This would suggest that exposing endothelial cells to high ambient glucose levels for a minimum of 1 week leads to a competitive type of inhibition of high-affinity myo-inositol uptake. The changes in myo-inositol metabolism and content and sorbitol levels mediated by glucose exposure were blocked by addition of the aldose reductase inhibitor, sorbinil, to the media, suggesting that these changes are caused by the accumulation of sorbitol by the cells. Exposure of bovine aorta endothelial cells to high ambient levels of glucose leads to accumulation of sorbitol in the cells, which is responsible for alterations in myo-inositol metabolism. These changes could result in alteration of endothelial cell membrane function and contribute to the pathology of diabetes mellitus.

Administration of an aldose reductase inhibitor induces a decrease of collagen fluorescence in diabetic rats

As a consequence of an increased flux through the sorbitol pathway fructose levels rise in various tissues in diabetes. Also, in vitro nonenzymatic fructosylation of protein induces the generation of fluorescence at a rate 10 times greater than glucosylation. The administration of sorbinil, an aldose reductase inhibitor known to lower tissue fructose concentration, to experimental diabetic rats led to a decrease in the fluorescence related to advanced Maillard products in their skin collagen. This effect is consistent with the in vivo occurrence of nonenzymatic fructosylation of collagen. A potential pathogenetic role for this posttranslational modification in diabetic complications should be considered.

Serum from diabetic patients enhances synthesis of arterial basement membrane-like material in cultured smooth muscle cells

The effect of serum from both type I and type II diabetic subjects on the metabolism of arterial basement membrane (BM)-like material was studied in cultures of rabbit aortic smooth muscle cells. The basement membrane-like material was isolated from the cell-layer by a combined sonication and centrifugation technique. Serum from type I diabetic persons added to the incubation medium increased statistically significantly the incorporation of L-[4,5]-3H-leucine into the basement membrane-like material as compared to serum from non-diabetic subjects (2P less than 0.05). The same effect was seen with serum from type II diabetic patients as compared to serum from nondiabetic subjects (2P less than 0.05). No effect of serum from type I diabetic persons was seen in degradation experiments. Incubation medium supplemented with normal serum and extra glucose neither changed the production of basement membrane-like material nor the disappearance rate of radioactive leucine from the basement membrane-like material in degradation experiments. The present study indicates that serum from diabetic subjects enhances the production of arterial basement membrane-like material from arterial smooth muscle cells in culture. The obtained data may be relevant for the understanding of the development of macroangiopathy among diabetic patients.

Endothelial plasma membrane is a glucocorticoid-regulated barrier for the uptake of glucose into the cell

The effect of glucose concentrations and hormones on glucose consumption, lactate, pyruvate, sorbitol and fructose formation of porcine aortic endothelial cells and human umbilical vein endothelial cells has been investigated. Endothelial cells have a high glycolytic activity which is saturated far below physiologic blood glucose levels (KM apparent less than 1 mmol/l). Glucocorticoids reduce glucose catabolism as a function of their concentration. Insulin, adrenaline, triiodothyronine and glucagon do not influence glucose consumption. Studies with the non-metabolizable analogue 3-O-methyl-D-glucose revealed that glucocorticoids slow down glucose transport into the endothelial cell. The passage of glucose through the cell membrane is the rate-limiting step of glucose utilization. Consequently, the intracellular glucose level is independent of the ambient glucose concentration and endothelial cells do not accumulate sorbitol under hyperglycaemic conditions since the affinity of aldose reductase for glucose is low.

Sorbitol accumulation is altered in type 1 (insulin-dependent) diabetes mellitus

Intracellular sorbitol accumulation has been implicated as an aetiological factor for many of the complications of diabetes mellitus. Erythrocyte sorbitol is found in higher concentration in Type 1 (insulin-dependent) diabetic patients than in normal subjects. When sorbitol accumulation is corrected for its immediate precursor glucose (sorbitol/glucose ratio), the polyol accumulation remains significantly greater in erythrocytes from the Type 1 diabetic. Erythrocytes from Type 1 diabetic patients exposed to normal extracellular glucose concentrations for 3 h in vitro, accumulate more sorbitol and fructose than normal cells in the same incubation system. Near-normalization of plasma glucose in Type 1 diabetic patients for 12 h did not result in normal erythrocyte sorbitol levels. The increased sorbitol accumulation in erythrocytes from Type 1 diabetic subjects may reflect similar activity in the lens and nerve in long-standing diabetes. This increased sorbitol production was found in most, but not all, individuals with diabetes and appears to be an acquired characteristic. Those factors influencing enhanced tissue sorbitol accumulation may be important in the aetiology of diabetes-associated complications.

Cytochemical correlates of atherosclerosis-resistant and susceptible lesions of the normal rabbit aorta

Quantitative cytochemical and microfluorimetric techniques were employed to compare mural intermediary metabolism--endothelial macromolecular uptake changes in spontaneous aortic-arteriosclerotic lesions of normolipemic New Zealand White rabbits. Specifically, mural succinic (SDH), lactic (LDH), and glucose-6-phosphate (G-6-PDH) dehydrogenase activities and luminal surface uptake of fluorescein isothiocyanate-conjugated bovine serum albumin (FITC-BSA) were measured in lesion sites abnormally resistant (calcified) and susceptible (proliferative) to dietary hypercholesterolemia. Calcified lesions exhibited severe (55-66%) diminution of SDH, LDH, and G-6-PDH activities within the involved inner mural zone and a comparable (68%) decline in luminal FITC-BSA uptake. Concomitant reductions in FITC-BSA uptake (30%) and marker enzymes of the predominant energy transducing pathways in arterial tissue, i.e., SDH (30%) and LDH (31%), were evidenced in proliferative foci, whereas G-6-PDH was augmented (52%) in comparison to nonlesioned aortic segments. These data lend additional support to the concept that endothelial uptake of plasma-borne macromolecules is coupled to oxidizable substrate requirements of inner avascular compartments of the arterial wall. It is postulated that diminished macromolecular transport in these degenerative lesions stems from reduced mural metabolic demands, and that pharmacologic reduction of vascular smooth muscle metabolism may depress uptake of sclerogenic macromolecules.

Immunohistochemical distribution of aldose reductase

Aldose reductase (AR) has been purified from canine kidneys, and a monospecific antibody against the enzyme prepared. These antibodies were used in an immunohistochemical test to detect tissue sites of aldose reductase in the dog, a species known to develop diabetic lesions morphologically identical to those seen in diabetic patients. Using this method, the enzyme has been demonstrated in numerous cell types, including lens epithelium, aortic endothelium and smooth muscle, Schwann cells of peripheral nerves, and, in the kidney, interstitial cells and cells of Henle's loop and the collecting tubules. Many other cells and tissues, including capillaries throughout the body, lack immunoreactive aldose reductase. The distribution of the immunoreactive enzyme is compatible with a potential role of the enzyme in the aetiology of some complications of diabetes, namely cataract, neuropathy, macroangiopathy and renal papillary necrosis, but not the microvascular complications.

The utilization by rabbit aorta of carbohydrates, fatty acids, ketone bodies, and amino acids as substrates for energy production

The ability of rabbit aorta to oxidize various substrates was studied to determine which of these compounds may be energy substrates for vascular smooth muscle (VSM). Glucose, ketone bodies, medium-chain length fatty acids, branched-chain amino acids, and glutamine all are oxidized at comparable rates on a molar basis. Some other amino acids, long chain fatty acids, pyruvate and glycerol also are oxidized, but at lower rates. The oxidation of 6 amino acids could not be detected. VSM was found to release ketone bodies when incubated in leucine beta-hydroxybutyrate or octanoate. This suggests that the acetoacetyl CoA and/or acetoacetate derived from these substrates is not completely oxidized. The oxidation rate of several substrates when measured individually is inhibited by 50-80% by the presence of a combination of other substrates in the medium. Under these conditions, glucose is a minor substrate for oxidative metabolism accounting for only 5% of O2 consumption. The oxidation rate of all the exogenous substrates together is calculated to account for less than half of the oxygen consumption; this finding indicates that an endogenous substrate must also be utilized.

Kinetics of insulin secretion following glucose infusion in patients with atherosclerotic peripheral vascular disease

Kinetics of insulin secretion following an i.v. glucose infusion, according to the protocol described by Cerasi and Luft, were studied in 19 patients with angiographically documented atherosclerotic peripheral vascular disease and in a group of appropriate controls without clinical signs of disease. No significant differences were noted between patients and controls in plasma cholesterol levels and in the K value following a standard i.v. glucose tolerance test. Blood glucose levels were significantly lower in the patients, whereas mean plasma insulin and triglyceride levels were significantly higher. Analysis of the glucose and insulin responses to the glucose infusion test indicated that 31.6% of the patients had a delayed and sluggish insulin response to the glucose load, fitting the criteria suggested for the diagnosis of prediabetes, versus 10% of the appropriate controls. In particular, simulation of the plasma insulin responses by a square-wave glucose stimulus, confirmed that in a significantly higher number of patients the early insulin peak was below normal limits. The results of this study suggest that increased insulin secretion is not present in patients with atherosclerotic vascular disease, in contrast to reports by other authors, and that inefficient insulin secretory mechanisms may be observed in these patients, thus possibly contributing to the development of the atherosclerotic disease.

Hydrolase activities in the rat aorta. I. Effects of diabetes mellitus and insulin treatment

Vascular disease in diabetics could arise in part from altered vessel wall catebolism. Specific activities of hydrolases in aortic smooth muscle cells from rats with streptozotocin-induced diabetes were measured. Enyzmes included: neutral alpha-glucosidase, alpha-mannosidase, and lysosomal N-acetyl beta-glucosaminidase, beta-galactosidase, cathepsin C, acid alpha-glucosidase, and acid cholesteryl esterase. After 4,8, and 11 weeks of diabetes, activities of all enzymes studied were decreased significantly in diabetic vessels, decreases ranging from 15% for cathepsin C to 62% for alpha-mannosidase. After 3 weeks of diabetes, insulin treatment for 1 week restored enzyme levels to normal. After 7 weeks of diabetes, 1 week of insulin treatment did not restore enzyme levels fully to normal (acid cholesteryl esterase was unchanged); 4 weeks of insulin did. Acid phosphatase and N-acetyl beta-glucosaminidase activities were reduced markedly in histochemical studies of diabetic aortas at all time periods and were restored by insulin treatment. Alloxan-induced diabetes gave results similar to those with streptozotocin. Significant decreases of aortic hydrolase activities, including those of lysosomes, occur in experimental diabetes mellitus and could contribute to accumulation of substrates in vascular smooth muscle cells.

The effects of anoxia on the morphology and composite metabolism of the intact aortic intima-media preparation

Paired samples of an intact rabbit aortic intima-media preparation were incubated for short periods under aerobic or anoxic conditions in Krebsbicarbonate buffer containing 6% albumin and 5 mM glucose. During aerobic incubation for as long as 1 h the preparation retained an electron microscopic (EM) appearance similar to that of tissue fixed in situ, and scanning EM confirmed the presence of an uninterrupted endothelial surface. After 2.5 min of anoxia there was widespread endothelial swelling, but the alterations in the EM appearance of these cells were not striking and did not progress during a subsequent 30 min aerobic incubation in fresh medium. After 10 min of anoxia there were marked and widespread alterations in endothelial cell structure, including loss of cell integrity, and numerous discrete interruptions in the endothelium were consistently observed on both transmission and scanning EM. After a subsequent 30 min aerobic incubation in fresh buffer, a major fraction of the luminal surface was denuded of endothelium. The aortic vascular smooth muscle cells did not exhibit evidence of irreversible anoxic injury after 2.5 or 10 min of anoxia or after subsequent aerobic incubation for 30 min. Exposure to anoxia for 10 min induced persistent alterations in the composite metabolism of the preparation during subsequent aerobic incubation in fresh medium; O(2) uptake was reduced, and the fraction of the glucose uptake that was accounted for by lactate production increased approximately 100%. The observations suggest that aortic endothelial cells are dependent upon respiration for the preservation of normal ultrastructure and cell integrity, and probably derive the major fraction of their energy requirements from reactions linked to respiration. Under the conditions employed in these experiments, short periods of anoxia did not induce EM evidence of irreversible anoxic injury in aortic vascular smooth muscle cells; this negative result is not incompatible with other data suggesting that these cells normally derive the major fraction of their energy requirements from respiration. Aortic intima-media does not exhibit a high rate of aerobic glycolysis under aerobic conditions which preserve a normal EM appearance of the preparation, but this pattern of metabolism can be induced by prior anoxic exposure.

Growth of rabbit aortic smooth muscle cells in serum from patients with juvenile diabetes

The effect of human diabetic serum on the growth of rabbit arterial smooth muscle cell cultures was studied in the stationary phase of growth. The serum was obtained from young, male, non-obese, juvenile diabetics and non-diabetics. The experiments were carried out using dialysed as well as non-dialysed serum. The concentration of cholesterol and triglycerides were equal in normal and diabetic serum. Media supplemented with diabetic serum from both short term and long term diabetics stimulated the outgrowth of the smooth muscle cells significantly (2p less than 0.01). A statistically significantly stimulation of growth was also observed using dialysed human diabetic serum (2p less than 0.05). Autoradiographic studies showed that the number of 3H-thymidine labelled cells and of cells in mitosis increased appreciably after incubation in diabetic human serum (2p less than 0.005). The present data show that human serum from juvenile diabetics contains a factor or factors which promote an excessive growth of arterial medial cells. The factor(s) is not lipids as hyperlipemia was not present nor is it glucose, aminoacids, fructose or ketones, as the growth effect remained after dialysis.

Morphology and metabolism of an aortic intima-media preparation in which an intact endothelium is preserved

An in vitro preparation of rabbit aortic "intima-media" previously shown to exhibit stable rates of respiration and glucose metabolism and the high rate of aerobic glycolysis considered characteristic of the metabolism of this tissue was subjected to electron microscopic examination. In samples examined immediately after the aortae were dissected free of adipose tissue and adventitia, under conditions similar to those now in common use, marked and widespread alterations in endothelial cell structure were present, including loss of cell integrity. The vascular smooth muscle cells retained a normal electron microscopic (EM) appearance. During subsequent incubation with 5 mM glucose in Krebs-Ringer bicarbonate (KRB), pH 7.4, under the conditions usually employed in studies of this preparation, large zones of the luminal surface were rapidly denuded of endothelium, and the remaining endothelial cells exhibited a wide range of ultrastructural alterations. The smooth muscle cells, however, continued to maintain a normal EM appearance. A method was developed to prepare segments of rabbit aortic intima-media which retained an intact layer of endothelium resembling that observed in tissue fixed in situ. During a 1-h incubation with 5 mM glucose in KRB, pH 7.4, gas phase 5% CO2/95% O2, containing 6% bovine serum albumin, the intact aortic intima-media preparation retains an essentially unmodified EM appearance and exhibits linear rates of respiration. Under these conditions the intact aortic intima-media preparation exhibits significantly higher rates of O2 uptake and glucose uptake than those observed in our previous preparation or in other reported aortic intima-media preparations. The intact aortic intima-media does not exhibit the high rate of aerobic glycolysis during in vitro incubation that has been considered characteristic of the metabolism of rabbit, rat, and swine aortic intima-media. In addition, the magnitude of the Pasteur effect was far greater than that observed in other aortic intima-media preparations. The data suggest that component cells of the aortic intima-media may derive a major fraction of their energy requirements from respiration; they raise further questions concerning the significance of the high rate of aerobic glycolysis observed when aortic intima-media preparations are incubated in vitro, and they suggest that documentation of the EM appearance of the endothelium in such preparations is desirable.

Neuropathic and vascular complications occurring in diabetes

Vascular and neuropathic complications of diabetes are a significant cause of morbidity and mortality. Symmetric polyneuropathy is the most common diabetic neuropathy. Treatment of the mononeuropathies consists of pain control and physical therapy to maintain muscle tone. Prognosis for recovery is excellent. Renal and retinal microangiopathy produce most of the clinically significant mortality and morbidity in diabetes. Recent advances in chronic hemodialysis and renal transplantation have improved the outlook for diabetics with end-stage nephropathy. The poor prognosis for retention of vision in diabetic malignant retinopathy has led to exploration of various forms of palliative therapy, including pituitary ablation, xenon arc coagulation, and laser treatment. Cardiovascular disease is more prevalent among diabetics than among the general population, according to a recent study, and mortality from this cause is three times higher. Animal studies linking aortic wall metabolism and atherosclerotic changes with hyperglycemia suggest that poor control of diabetes may play a role in the development of vascular lesions.