Intermittent Hypoxia Prevents Myocardial Mitochondrial Ca2+ Overload and Cell Death during Ischemia/Reperfusion: The Role of Reactive Oxygen Species

It has been documented that reactive oxygen species (ROS) contribute to oxidative stress, leading to diseases such as ischemic heart disease. Recently, increasing evidence has indicated that short-term intermittent hypoxia (IH), similar to ischemia preconditioning, could yield cardioprotection. However, the underlying mechanism for the IH-induced cardioprotective effect remains unclear. The aim of this study was to determine whether IH exposure can enhance antioxidant capacity, which contributes to cardioprotection against oxidative stress and ischemia/reperfusion (I/R) injury in cardiomyocytes. Primary rat neonatal cardiomyocytes were cultured in IH condition with an oscillating O₂ concentration between 20% and 5% every 30 min. An MTT assay was conducted to examine the cell viability. Annexin V-FITC and SYTOX green fluorescent intensity and caspase 3 activity were detected to analyze the cell death. Fluorescent images for DCFDA, Fura-2, Rhod-2, and TMRM were acquired to analyze the ROS, cytosol Ca²⁺, mitochondrial Ca²⁺, and mitochondrial membrane potential, respectively. RT-PCR, immunocytofluorescence staining, and antioxidant activity assay were conducted to detect the expression of antioxidant enzymes. Our results show that IH induced slight increases of O₂^−· and protected cardiomyocytes against H₂O₂- and I/R-induced cell death. Moreover, H₂O₂-induced Ca²⁺ imbalance and mitochondrial membrane depolarization were attenuated by IH, which also reduced the I/R-induced Ca²⁺ overload. Furthermore, treatment with IH increased the expression of Cu/Zn SOD and Mn SOD, the total antioxidant capacity, and the activity of catalase. Blockade of the IH-increased ROS production abolished the protective effects of IH on the Ca²⁺ homeostasis and antioxidant defense capacity. Taken together, our findings suggest that IH protected the cardiomyocytes against H₂O₂- and I/R-induced oxidative stress and cell death through maintaining Ca²⁺ homeostasis as well as the mitochondrial membrane potential, and upregulation of antioxidant enzymes.

Baicalein Ameliorates Pulmonary Arterial Hypertension Caused by Monocrotaline through Downregulation of ET-1 and ETAR in Pneumonectomized Rats

Baicalein (BE) extracted from Scutellaria baicalensis Georgi is able to alleviate various cardiovascular and inflammatory diseases. However, the effects of BE on pulmonary arterial hypertension (PAH) remain unknown. Therefore, the present study aimed to examine whether BE ameliorates pneumonectomy and monocrotaline-induced PAH in rats and further investigate the underlying molecular mechanisms. Administration of BE greatly attenuated the development of PAH as evidenced by an improvement of its characteristic features, including elevation of right ventricular systolic pressure, right ventricular hypertrophy, and pulmonary vascular remodeling. Moreover, the increased protein expression of endothelin-1 (ET-1) and ETA receptor (ETAR), superoxide overproduction, and activation of Akt/ERK1/2/GSK3[Formula: see text]/[Formula: see text]-catenin pathway that occurred in the lungs of PAH rats were markedly reversed by BE treatment. Compared with the untreated PAH rats, higher expression of endothelial nitric oxide synthase (eNOS), but lower levels of inducible nitric oxide synthase and vWF were observed in BE-treated PAH rats. Collectively, treatment with BE remarkably attenuates the pathogenesis of PAH, and the protection of BE may be associated with suppressing Akt/Erk1/2/GSK3[Formula: see text]/[Formula: see text]-catenin/ET-1/ETAR signaling and preventing endothelial dysfunction. These results suggest that BE is a potential agent for treatment of PAH.

Combining Induced Pluripotent Stem Cells and Genome Editing Technologies for Clinical Applications

In this review, we introduce current developments in induced pluripotent stem cells (iPSCs), site-specific nuclease (SSN)-mediated genome editing tools, and the combined application of these two novel technologies in biomedical research and therapeutic trials. The sustainable pluripotent property of iPSCs in vitro not only provides unlimited cell sources for basic research but also benefits precision medicines for human diseases. In addition, rapidly evolving SSN tools efficiently tailor genetic manipulations for exploring gene functions and can be utilized to correct genetic defects of congenital diseases in the near future. Combining iPSC and SSN technologies will create new reliable human disease models with isogenic backgrounds in vitro and provide new solutions for cell replacement and precise therapies.

Intermittent Hypoxia Inhibits Na+-H+ Exchange-Mediated Acid Extrusion Via Intracellular Na+ Accumulation in Cardiomyocytes

BACKGROUND/AIMS

Intermittent hypoxia (IH) has been shown to exert preconditioning-like cardioprotective effects. It also has been reported that IH preserves intracellular pH (pHi) during ischemia and protects cardiomyocytes against ischemic reperfusion injury. However, the exact mechanism is still unclear.

METHODS

In this study, we used proton indicator BCECF-AM to analyze the rate of pHi recovery from acidosis in the IH model of rat neonatal cardiomyocytes. Neonatal cardiomyocytes were first treated with repetitive hypoxia-normoxia cycles for 1-4 days. Cells were then acid loaded with NH4Cl, and the rate of pHi recovery from acidosis was measured.

RESULTS

We found that the pHi recovery rate from acidosis was much slower in the IH group than in the room air (RA) group. When we treated cardiomyocytes with Na+-H+ exchange (NHE) inhibitors (Amiloride and HOE642) or Na+-free Tyrode solution during the recovery, there was no difference between RA and IH groups. We also found intracellular Na+ concentration ([Na+]i) significantly increased after IH exposure for 4 days. However, the phenomenon could be abolished by pretreatment with ROS inhibitors (SOD and phenanathroline), intracellular calcium chelator or Na+-Ca2+ exchange (NCX) inhibitor. Furthermore, the pHi recovery rate from acidosis became faster in the IH group than in the RA group when inhibition of NCX activity.

CONCLUSIONS

These results suggest that IH would induce the elevation of ROS production. ROS then activates Ca2+-efflux mode of NCX and results in intracellular Na+ accumulation. The rise of [Na+]i further inhibits the activity of NHE-mediated acid extrusion and retards the rate of pHi recovery from acidosis during IH.

Pulseless electrical activity in acute massive pulmonary embolism during thrombolytic therapy

We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for 6 min. His electrocardiogram (ECG) on arrival in the emergency department displayed sinus tachycardia, an S wave in lead I, a Q wave in lead III, incomplete right bundle branch block (RBBB), T-wave inversion (TWI) in leads V1–V3, ST elevation in leads aVR and V1, and ST depression in leads I, II, III, aVF, and V4–V6. These characteristic ECG changes might have prognostic value for clinical deterioration. He recovered after treatment. After discharge, the ECG showed resolution of TWI in leads V1–V3 and incomplete RBBB, suggesting recovery from right ventricular dysfunction, which was confirmed by an echocardiogram on follow in the outpatient department.

Angiotensin converting enzyme DD genotype is associated with acute coronary syndrome severity and sudden cardiac death in Taiwan: a case-control emergency room study

Background

Angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms have been associated with acute coronary syndrome (ACS); however, several controversial results have also been found in different studied populations. This hospital-based, emergency room, case-control study in Taiwan retrospectively investigated 111 ACS patients, and 195 non-coronary subjects as a control group, to study the effects of ACE I/D polymorphism in the most urgent ACS patients. ACE I/D polymorphisms were determined by polymerase chain reaction-based assays and their associations with ACS risk, severity, and sudden cardiac death were determined.

Results

The ACE DD genotype was associated with ACS incidence. The DD genotype was associated with a significant 4-fold higher risk of ACS in multivariate analysis (odds ratio (OR) = 4.295; 95% confidence interval (CI): 1.436-12.851, p = 0.009), and a 3.35-fold higher risk of acute myocardial infarction. DD genotype carriers also had more than 3-fold higher risks of stenosis in all the three coronary arteries, left anterior descending artery infarction, and anterior wall infarction. In addition, the DD genotype was also associated with a higher risk of sudden cardiac death (OR = 6.484, 95% CI: 1.036-40.598, p = 0.046).

Conclusions

This study demonstrated that the ACE DD genotype is an independent risk factor for ACS, and in particular, for acute myocardial infarction. In addition, the ACE DD genotype is also associated with greater ACS severity and a higher risk of sudden cardiac death. ACE genotyping is recommended for patients with a history of ACS, and more intensive preventive care is suggested for patients with the DD genotype.

The toxic effect of Amiodarone on valve formation in the developing heart of zebrafish embryos

BACKGROUND

Amiodarone is a class D drug given to treat arrhythmia, including pregnant women, but its effects on the developing heart have not been studied. Although some studies have suggested that this drug is safe for fetuses, they have been conducted on mothers with fetuses at or beyond six months of gestational age.

RESULTS

The occurrence of valve defect was positively proportional to Amiodarone concentrations over 9 μM, but not lower than 6 μM. Ectopic overexpression of versican was observed at the atrioventricular canal of the Amiodarone-treated embryos at 15 μM (EC(50)). VE-cadherin (cdh5), normally downregulated at the endocardial cushion, was also ectopically overexpressed in the Amiodarone-treated embryos. Knockdown of either versican or cdh5 in the Amiodarone-treated embryos could rescue the valve defect caused by Amiodarone.

CONCLUSIONS

By inducing versican ectopical overexpression, leading, in turn, to cdh5 ectopical overexpression, Amiodarone treatment causes failure of cardiac valve formation in zebrafish embryos.

Inhibitory effect of n-butylidenephthalide on neointimal hyperplasia in balloon injured rat carotid artery

This investigation was designed to determine the inhibitory effects and mechanisms of n-butylidenephthalide (BP) from Angelica sinensis on smooth muscle cell (SMC) proliferation in vitro and in balloon injured rat carotid artery. Treatment of cultured rat aorta SMC-derived A7r5 cells with 25-100 μg/mL BP significantly inhibited the proliferation and arrested the cell cycle in G(0)/G(1) phase. BP induced the expression and migration of Nur77 from the nucleus to the cytoplasm. Among signal pathways, JNK and p38 MAPK were phosphorylated after BP treatment. In vivo, the neointimal area of common carotid artery 2 weeks after balloon injury reduced significantly in Sprague-Dawley rats treated with 150-300 mg/kg BP compared with the control. The proliferative activity indicated by immunohistochemical detection of Ki-67 positive cells in the neointima was significantly decreased in the 60-300 mg/kg BP treatment groups. The apoptotic activity indicated by cleaved caspase-3 positive cells and Nur77 positive cells in the neointima was significantly increased in rats treated with 60-300 mg/kg BP. This study demonstrated BP inhibited neointimal hyperplasia in balloon injured rat carotid artery due to its dual effects of proliferative inhibition and apoptotic induction on SMCs. Up-regulation of Nur77 gene may partly explain the antihyperplasia activity of BP on the neointima.

Plasma C-reactive protein and 5-lipoxygenase-activating protein gene promoter poly-A polymorphism in patients with coronary artery disease

OBJECTIVES

The purpose of this study was to explore the possible associations of the 5-lipoxygenase-activating protein (FLAP) poly-A genotype, plasma high-sensitivity C-reactive protein (hsCRP) and the extent score of coronary artery disease (CAD).

METHODS

The 17A/21A genotypes and plasma hsCRP levels were determined in 555 Chinese patients, 424 with and 131 without CAD. The luciferase reporter assay was performed to explore the functional significance of promoter poly-A polymorphism.

RESULTS

CAD patients showed significantly higher plasma hsCRP (p = 0.007) than non-CAD subjects, but no differences in the 17A allele carriers and frequency. The extent score of CAD was significantly correlated with plasma hsCRP (p = 0.03). Furthermore, the 17A allele carriers showed significantly higher hsCRP than the 21A homozygotes (p = 0.02). Multiple linear regression analysis documented an impact of the poly-A genotype on plasma hsCRP (p = 0.03). In vitro, the 17A construct was found to have greater promoter activity than the 21A construct (p = 0.02).

CONCLUSIONS

The present study demonstrated a significant correlation of FLAP gene promoter 17A allele carriers with higher plasma hsCRP levels in patients with CAD. This association might be related to the increased transcriptional activity of the FLAP gene and the resulting pro-inflammatory effect on the 5-lipoxygenase pathway.

Plasma adiponectin, T94G gene polymorphism and PAI-1 in patients with and without hypertension

BACKGROUND

Reduced adiponectin level has been associated with metabolic syndrome, type 2 diabetes, coronary artery disease and gene polymorphisms, but the interrelationships of T94G genotype, plasma adiponectin and plasminogen activator inhibitor-1 (PAI-1) are less understood.

PATIENTS AND METHODS

The T94G genotypes and plasma levels of adiponectin, and PAI-1 were determined in 568 Chinese patients, 212 with and 356 without hypertension, to study the possible associations of T94G genotype, plasma adiponectin, PAI-1 and blood pressure.

RESULTS

Hypertensive patients showed significantly lower plasma adiponectin (9.7 +/- 11.1 vs. 11.5 +/- 10.0 microg/ml, p = 0.04) and higher PAI-1 (p < 0.001) levels but not significantly greater adiponectin TT genotype percentage (38.7 vs. 33.5%) and T allele frequency (0.620 vs. 0.585) than normotensive subjects. Plasma adiponectin was inversely related to PAI-1 activity (r = -0.09, p = 0.03) and antigen (r = -0.202, p < 0.001). Furthermore, the TT genotypic group showed significantly lower plasma adiponectin level (10.4 +/- 10.5 vs. 13.4 +/- 10.8 mug/ml, p = 0.03) and higher plasma PAI-1 activity (17.0 +/- 9.7 vs. 13.5 +/- 7.6 IU/ml, p = 0.003) and antigen (32.3 +/- 22.7 vs. 25.9 +/- 14.7 ng/ml, p = 0.01) than the GG genotypic group. Multiple linear regression analysis in all study subjects, in men and in normotensives documented an impact of adiponectin T94G genotype on plasma levels of adiponectin (p = 0.007, 0.003 and 0.03) and PAI-1 activity (p = 0.02, 0.03 and 0.04) and antigen (p = 0.03, 0.007 and 0.04) after adjustment for potential confounding factors.

CONCLUSIONS

The present study demonstrated a significant correlation of the TT genotype with lower plasma adiponectin and higher plasma PAI-1 levels in a Chinese population. The contribution of this genotype seemed greater in men and normotensives. It suggested the adiponectin gene T94G polymorphism might affect the regulation of circulating adiponectin and PAI-1.

Association of interleukin-6 gene G-174C polymorphism and plasma plasminogen activator inhibitor-1 level in Chinese patients with and without hypertension

BACKGROUND

The interleukin-6 (IL-6) gene promoter G-174C polymorphism has been associated with insulin resistance, hypertension, and coronary artery disease; however, its relationship with plasma PAI-1 level has not yet been studied.

METHODS

The G-174C genotypes and plasma PAI-1 antigen and activity were determined in 424 Chinese subjects, 207 with hypertension and 217 without, to study the possible effects of IL-6 genotypes on the regulation of PAI-1 and blood pressure.

RESULTS

Hypertensive patients showed significantly greater percentage of IL-6 GG genotype (51.7% v 33.2%, P < .001) and G allele frequency (71.7% v 59%, P < .001) than normotensive subjects. The GG genotypic group had significantly higher plasma PAI-1 activity (16.1 +/- 9.8 v 12.3 +/- 7.5 IU/mL, P = .03) and antigen (32.4 +/- 23.2 v 23.2 +/- 13.5 ng/mL, P = .01) than the CC genotypic group, with intermediate values in the GC genotypic group (15.9 +/- 9.0 IU/mL and 29.1 +/- 17.5 ng/mL). Multiple linear regression analysis in all study subjects and in normotensive subjects documented an independent dominant effect of IL-6 G-174C gene polymorphism on plasma levels of PAI-1 activity (P = .02 and .01) and antigen (P = .02 and .03) after log transformation and adjustment for confounding factors.

CONCLUSIONS

The present study showed a positive association of the IL-6 GG genotype with hypertension and with elevated plasma PAI-1 level in normotensive individuals in a Chinese population in Taiwan. Our findings suggest that the IL-6 gene promoter G-174C polymorphism may affect the regulation of PAI-1 and blood pressure through an inflammatory mechanism.

Association of PAI-1 gene promoter 4g/5g polymorphism with plasma PAI-1 activity in Chinese patients with and without hypertension

BACKGROUND

The PAI-1 gene promoter 4G/5G polymorphism was found to be associated with plasma PAI-1 activity in white but not yet in Chinese patients. Hypertension might exaggerate the 4G/5G genotype effect on plasma PAI-1.

METHODS

The 4G/5G genotypes and plasma PAI-1 levels were determined in 565 Chinese, 211 with and 354 without hypertension to study the genotype effect and the mode of gene-environment interaction.

RESULTS

Hypertensive patients showed significantly higher plasma PAI-1 activity (18.2 +/- 10.0 v 14.6 +/- 8.8 IU/mL, P <.001) than normotensive subjects, and also higher body mass index (BMI) and plasma triglyceride (TG), but had neither significant difference in the 4G allele frequency (0.531 v 0.549) nor in the 4G/4G genotype percentage (24.6% v 26.5%). The 4G/4G genotypic group had higher plasma PAI-1 activity (17.6 +/- 10.2 v 14.5 +/- 7.3 IU/mL, P =.027) than the 5G/5G genotypic groups, but the statistic significance was present in women (18.1 +/- 10.0 v 14.8 +/- 6.9 IU/mL, P =.025) and not in men (17.2 +/- 10.5 v 14.3 +/- 7.7 IU/mL, P =.39) after log transformation. Multiple regression analysis of all cases documented the independent effect of BMI (P =.000), plasma TG (P =.000), age (P =.006), gender (P =.046), and the PAI-1 genotype (4G/4G v 5G/5G, P =.012) on plasma PAI-1 activity. However, the significant association of 4G/4G genotypes with higher plasma PAI-1 activity was present in women (P =.004) but not in men. There was a significant difference (P =.04) on the plasma TG-PAI-1 activity correlations between the 4G/4G (r = 0.521) and 5G/5G (r = 0.117) genotypic groups of hypertensive patients.

CONCLUSIONS

The present study showed that the 4G/4G genotype was associated with elevated plasma PAI-1 activity in Chinese patients with and without hypertension. The contribution of the PAI-1 genotype seemed larger in women. In hypertensives carrying the 4G/4G genotype, higher TG was correlated with higher PAI-1, suggesting a possible contribution of gene-environmental interaction to their high risk for atherothrombotic disease.

Carotid wall thickening, left ventricular hypertrophy, and insulin resistance in patients with hypertension

BACKGROUND

Insulin resistance was associated with hypertension and coronary artery disease, and might play a role in the development of carotid atherosclerosis and cardiac hypertrophy.

METHODS

The relationship of insulin resistance, estimated by steady-state plasma glucose (SSPG) with the B-mode ultrasound-measured carotid intima-medial thickness (IMT) and the M-mode echocardiographically determined left ventricular mass (LVM), was examined in 82 Chinese patients with hypertension.

RESULTS

Insulin-resistant patients with obesity, glucose intolerance, dyslipidemia, and hypofibrinolysis show no significantly greater LVM index and carotid IMT than nonresistant individuals. Patients with either left ventricular hypertrophy or carotid wall thickening did not present significantly higher SSPG than those without these abnormalities. Neither carotid IMT nor LVM was associated with SSPG on multiple regression analysis.

CONCLUSIONS

The study suggested that insulin resistance was not an important contributor for carotid thickening and cardiac hypertrophy in Chinese patients with hypertension.

Carotid thickening, cardiac hypertrophy, and angiotensin converting enzyme gene polymorphism in patients with hypertension

An insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene has been associated with increased risk for myocardial infarction, cardiomyopathy, carotid thickening, and cardiac hypertrophy. However, a conclusive agreement about the role of ACE genotype in the genetics of cardiovascular disease has not yet been reached. This study was undertaken to investigate the relationship of the I/D polymorphism of the ACE gene with carotid intima-media thickness (IMT) and left ventricular mass (LVM) in 175 Chinese patients with mild-to-moderate hypertension. The I/D genotypes were detected by the polymerase chain reaction using primers flanking the polymorphic region in intron 16 of the ACE gene. The IMT was measured in the common carotid and carotid bifurcation by B-mode ultrasound. The LVM was calculated with M-mode echocardiographic measures of the left ventricle. Patients with the DD genotype (n = 41) showed significant greater carotid IMT (1.593 +/- 0.879 v 1.309 +/- 0.703 and 1.171 +/- 0.583 mm, P = .01) but insignificant higher LVM index (123.8 +/- 36.6 v 123.7 +/- 37.4 and 118.2 +/- 33.0 g/m2, P = .61) than did those with the DI (n = 69) and II (n = 65) genotypes. The deletion polymorphism of the ACE gene (P = .04) was a significant predictor for carotid IMT on multiple regression analysis, controlling all the potential confounding factors including age (P = .001), systolic blood pressure (P = .09), smoking (P = .08), and plasma tissue plasminogen activator antigen (P = .03), but the LVM correlated only with age (P = .02), sex (P < .001), and body mass index (P < .001). These results indicated that the DD genotype of the ACE gene could be considered a risk factor for the development of early atherosclerosis in carotid arteries but not for left ventricular hypertrophy in the hypertensive population.

Left ventricular mass, carotid wall thickness, and angiotensinogen gene polymorphism in patients with hypertension

A missense gene mutation with methione-to-threonine amino acid substitution at codon 235 (M235T) of angiotensinogen (AGT) has been associated with higher plasma AGT levels and may influence the pathogenesis of cardiac hypertrophy and atherosclerosis. This study was undertaken to investigate the relationship of the M235T polymorphism of the AGT gene with left ventricular mass (LVM) and carotid intima-media thickness (IMT) in 175 Chinese patients with hypertension. The M235T mutation was detected by a mispairing primer method to create a BstUI restriction site in the polymerase chain reaction. The LVM was calculated with M-mode echocardiographic measures of the left ventricle. The IMT was measured in the common carotid and carotid bifurcation by B-mode ultrasound. Patients with the TT genotype (n = 106) were found to have significantly greater LVM index than those with the MM (n = 32) and MT (n = 37) genotypes (129.2 +/- 34.3 v 112.5 +/- 38.3 and 107.4 +/- 30.0 g/m2, P = .002), but the carotid IMT showed insignificant differences among three genotypic groups (1.320 +/- 0.703, 1.349 +/- 0.777, and 1.309 +/- 0.797 mm, P = .97). The M235T polymorphism (P = .004) was a significant predictor for LVM on multiple regression analysis, controlling all the potential confounding factors including age (P = .04), gender (P = .000), body mass index (P = .000), and so on, but the carotid IMT correlated only with age (P = .000), smoking (P = .02), and tissue plasminogen activator antigen (P = .02). These results indicated that the TT genotype of the AGT gene could be considered a risk factor for the development of cardiac hypertrophy, but not for carotid atherosclerosis in the hypertensive population.

Plasminogen activator inhibitor-1 and angiotensin I converting enzyme gene polymorphism in patients with hypertension

Deletion polymorphism of angiotensin I-converting enzyme (ACE) gene has been reported to be an independent risk factor for myocardial infarction. Plasminogen activator inhibitor-1 (PAI-1) was proposed to be a link between the renin-angiotensin system and thrombotic risk. This study was undertaken to investigate the possible association between the insertion/deletion (I/D) polymorphism of the ACE gene and plasma PAI-1 levels in 160 patients with mild-to-moderate hypertension. The I/D genotypes were determined by polymerase chain reaction with oligonucleotide primers flanking the polymorphic region in intron 16 of the ACE gene. Baseline levels of PAI-1 antigen and activity and tissue plasminogen activator (t-PA) antigen were determined in fasting morning plasma samples. It was found that patients with homozygote deletion (DD, n = 37) ACE genotype did not have significantly higher plasma levels of PAI-1 antigen (31.2 +/- 15.6 ng/mL v 28.4 +/- 15.1 ng/mL or 27.2 +/- 13.2 ng/mL, P = .42), PAI-1 activity (16.2 +/- 10.6 IU/mL v 14.1 +/- 9.4 IU/ mL or 15.0 +/- 9.9 IU/mL, P = .60), or t-PA antigen (14.6 +/- 6.0 ng/mL v 13.4 +/- 4.9 ng/mL or 14.6 +/- 5.7 ng/mL, P = .40) as compared to those with heterozygote (DI, n = 67) or homozygote insertion (II, n = 56) genotypes. On multiple regression analysis, the ACE genotypes did not appear to be significant predictors for plasma PAI-1 levels and t-PA antigen after adjustment with age, sex, body mass index, plasma triglyceride, cholesterol, and glucose. In conclusion, the results indicated that the I/D polymorphism of the ACE gene was not related to plasma PAI-1 levels in a Chinese population with hypertension. The ACE genotypes may not have a role in influencing the fibrinolysis in hypertension.

Angiotensin I converting enzyme gene polymorphism and insulin resistance in patients with hypertension

BACKGROUND

The homozygote deletion (DD) genotype of the angiotensin I converting enzyme (ACE) gene has been shown to be associated with an increased risk of coronary heart disease independent of other risk factors.

OBJECTIVE

To investigate the possible association of the insertion/deletion (I/D) polymorphism of the ACE gene with insulin resistance in a Chinese population with and without hypertension.

SUBJECTS AND METHODS

The I/D polymorphism of the ACE gene was determined for 361 Chinese including 148 women and 96 men with normal blood pressures and 64 male and 53 female patients with mild-to-moderate hypertension. Insulin resistance was estimated by the insulin suppression test and glucose intolerance evaluated with an oral glucose-tolerance test for all of the subjects.

RESULTS

Three hypertensive subgroups with DD, DI and II genotypes having similar ages and body mass indexes presented insignificantly different degrees of glucose intolerance and insulin resistance both among men and among women. Similar results were found for normotensive subjects. In addition, ACE genotypes were not significant predictors of insulin resistance and glucose intolerance either among men or among women after adjustment for age, body mass index, and hypertension.

CONCLUSION

The present data indicated that the I/D polymorphism of the ACE gene was not related to insulin resistance for Chinese hypertensive and normotensive subjects. The increased risk of coronary heart disease associated with the DD genotype need not be mediated through the mechanism of insulin resistance and glucose intolerance for Chinese patients with hypertension.

Gemfibrozil treatment of hypertriglyceridemia: improvement on fibrinolysis without change of insulin resistance

The fibrinolytic and metabolic changes associated with gemfibrozil treatment of hypertriglyceridemia were evaluated in 16 patients with type IV hyperlipidemia by criteria of triglyceride levels > 250 mg/dl and total cholesterol levels < 220 mg/dl. The plasma triglyceride level was significantly lower (323 +/- 71 vs 189 +/- 57 mg/dl; p = 0.000) and high-density lipoprotein cholesterol level significantly higher (33.5 +/- 4.6 vs 38.0 +/- 6.7 mg/dl; p = 0.005) after 3 to 4 months of gemfibrozil treatment. However, the glucose and insulin metabolism measured by oral glucose challenge and insulin suppression tests showed no significant changes after gemfibrozil therapy. In contrast, plasma plasminogen activator inhibitor-1 antigen (36.9 +/- 12.4 vs 27.3 +/- 11.4 ng/ml; p = 0.008) and activity (15.5 +/- 5.5 vs 11.8 +/- 3.0 IU/ml; p = 0.009) and tissue plasminogen activator antigen (13.2 +/- 4.0 vs 10.4 +/- 3.7 ng/ml; p = 0.007) were significantly depressed, and tissue plasimogen activator activity (0.57 +/- 0.31 vs 0.69 +/- 0.38 IU/ml; p = 0.015) was significantly elevated by gemfibrozil. The data indicate that lowering plasma triglyceride and raising high-density lipoprotein cholesterol levels by gemfibrozil treatment also improved the fibrinolytic system without changes of insulin resistance and glucose intolerance in patients with isolated hypertriglyceridemia.

Angiotensin I converting enzyme gene polymorphism in Chinese patients with hypertension

Reports from different ethnic populations failed to show consistent findings on the association of hypertension with insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene. In this population association study in Chinese, we compared the distribution of the ACE genotypes and allele frequency in 150 healthy controls with normal blood pressure and 148 hypertensive patients categorized by age. Although the frequencies of homozygote deletion (DD) genotype and deletion allele were greater in Chinese with hypertension than in normotensive controls (0.23 vs 0.13 and 0.44 v 0.37, respectively), the differences were not significant by chi2 analysis (P = .07 and .09, respectively). Furthermore, we did not find the trend of decreasing number of DD genotype in older hypertensive Chinese patients. The results indicated a much lower prevalence of ACE/DD genotype in Chinese than in Caucasians and a modest association between I/D polymorphism of the ACE gene and hypertension in Chinese.

Effect of doxazosin on fibrinolysis in hypertensive patients with and without insulin resistance

The fibrinolytic and metabolic changes associated with doxazosin treatment were evaluated in 20 patients with mild to moderate hypertension. Steady-state plasma glucose (SSPG) concentration was used to subdivide hypertensive patients into two groups of 10 each: Insulin-resistant (SSPG > 190 mg/dl) and nonresistant (SSPG < 190 mg/dl). The blood pressure was normalized after 4 to 6 months of doxazosin treatment in both groups, but it was associated with significantly lower fasting plasma triglyceride level, lower integrated insulin response to a 75 gm oral glucose load, lower SSPG concentration, significant decreases in plasma plasminogen activator inhibitor type one antigen and activity and tissue plasminogen activator antigen, and a significant increase in tissue plasminogen activator activity only in the insulin-resistant group but not in the nonresistant group. It was also noted that the improvement of the fibrinolytic and metabolic abnormalities in the insulin-resistant group tended to return to the less abnormal levels seen in the non-resistant group. The data suggested that doxazosin treatment of hypertension attenuated much of the abnormalities of insulin resistance but had little effect on insulin-sensitive patients. It may support a link between impaired fibrinolysis and insulin resistance in patients with hypertension.

Impaired fibrinolysis and insulin resistance in patients with hypertension

Plasma plasminogen activator inhibitor type 1 (PAI-1) and tissue plasminogen activator (tPA) antigens and activities were measured in 28 patients with hypertension and 12 normal controls. Steady state plasma glucose (SSPG) concentrations were also determined after an infusion of somatostatin, insulin and glucose. Patients with hypertension were further subdivided into two groups: insulin resistance (SSPG > 190 mg/dL, n = 14) and no insulin resistance (SSPG < 190 mg/dL, n = 14). As compared to normal controls, hypertensive patients, either with or without insulin resistance, had a significant (P < .005) increases in PAI-1 activity (18.6 +/- 1.3 upsilon 8.1 +/- 0.8 IU/mL), PAI-1 antigen (31.1 +/- 2.0 upsilon 12.7 +/- 0.9 ng/mL) and tPA antigen (15.5 +/- 0.9 upsilon 8.8 +/- 0.9 ng/mL), and significant decrease in tPA activity (0.43 +/- 0.05 upsilon 1.02 +/- 0.16 IU/mL) than normotensive controls. Furthermore, hypertensive patients with insulin resistance had significantly higher PAI-1 activity (22.0 +/- 2.2 upsilon 15.3 +/- 0.8 IU/mL, P = .006) and tPA antigen (17.4 +/- 1.2 upsilon 13.6 +/- 1.3 ng/mL, P = .02) than did hypertensive patients without insulin resistance. However, PAI-1 antigen was insignificantly higher (34.1 +/- 2.9 upsilon 28.1 +/- 2.4 ng/mL, P = .06) and tPA activity insignificantly lower (0.42 +/- 0.08 upsilon 0.43 +/- 0.08 IU/mL, P = .47) in hypertensive patients with insulin resistance than in those without insulin resistance. In addition, PAI-1 activity and tPA antigen were significantly correlated with blood pressure, SSPG, triglyceride, HDL-cholesterol and integrated glucose response to an oral load of 75 g glucose. Thus, patients with hypertension have impaired fibrinolytic activity due to increased PAI-1 when compared to normotensive controls, and the magnitude of this fibrinolytic defect is greater in hypertensive patients who have insulin resistance. Insulin resistance with associated metabolic abnormalities may be one of the causes for impaired fibrinolysis in hypertension.

Evidence that polymorphism of the angiotensin I converting enzyme gene may be related to idiopathic dilated cardiomyopathy in the Chinese population

Angiotensin I-converting enzyme (ACE) is responsible for the production of angiotension II and the breakdown of kinins, leading to increased blood pressure (BP), induction of vascular smooth muscle cell proliferation, and the stimulation of myocardial-cell hypertrophy. A 287 bp insertion/deletion polymorphism in intron 16 of the ACE gene was examined by polymerase chain reaction in a cross-sectional study of 35 patients with idiopathic dilated cardiomyopathy (IDC) and 35 patients with normally functioning hearts (NT). Compared with the deletion/deletion (D/D) frequency in the control population, the frequency of the deletion allele was 0.757 in IDC patients and 0.600 in NTs; the difference between observed alleles in all subjects in each group was significant (x2 = 3.96; P < 0.05). The data thus provide evidence in favor of an association between idiopathic dilated cardiomyopathy and a polymorphism at the ACE locus (17q23), thus implicating this locus, and possibly a genetic variant of ACE, itself, in human idiopathic dilated cardiomyopathy.

Increased oxidizability of plasma low density lipoprotein from patients with coronary artery disease

Oxidative modification of lipoproteins may play a crucial role in the pathogenesis of atherosclerosis. This study was designed to examine whether increased lipid peroxides and/or oxidative susceptibility of plasma lipoproteins occur in patients with coronary artery disease. The levels of lipid peroxides, estimated as thiobarbituric acid-reactive substances (TBARS), were significantly greater in the plasma and very low density lipoprotein (VLDL) of symptomatic patients with coronary artery disease than in those of healthy persons, but the TBARS levels of low density lipoprotein (LDL) and high density lipoprotein (HDL) showed insignificant difference between patients and normals. To evaluate the oxidative susceptibility of lipoproteins, we employed in vitro Cu2+ oxidation of lipoproteins monitored by changes in fluorescence, TBARS level, trinitrobenzene sulfonic acid (TNBS) reactivity, apolipoprotein immunoreactivity and agarose gel electrophoretic mobility. While pooled VLDL and LDL of normal controls were oxidized at 5-10 microM Cu2+, pooled VLDL and LDL of patients with coronary artery disease were oxidized at 1-2.5 microM Cu2+, i.e., at relatively lower oxidative stress. At 5 microM Cu2+, VLDL and LDL of patients with coronary artery disease still showed a faster oxidation rate, judged by the rate of fluorescence increase, higher TBARS level, less TNBS reactivity, greater change in apo B immunoreactivity and higher electrophoretic mobility than those of normal controls. However, the difference on the oxidizability of HDL was insignificant for patients vs. normals. In conclusion, we have shown that plasma VLDL and LDL of patients with coronary artery disease are more susceptible to in vitro oxidative modification than those of healthy persons. The data suggest that enhanced oxidizability of plasma lipoproteins may be an important factor influencing the development of coronary artery disease.

Oxidized low-density lipoprotein enhances monocyte-endothelial cell binding against shear-stress-induced detachment

Oxidatively modified low-density lipoprotein may be involved in the adherence of blood monocytes to arterial endothelium in the early atherosclerotic lesion. The present study employed static assays and flow-chamber technique to investigate the adhesive interactions between isolated human blood monocytes and cultured human umbilical vein endothelial cell (EC) monolayer pretreated with Cu(2+)-oxidized human plasma LDL (Ox-LDL) and native LDL (N-LDL). The cell-cell binding force was estimated by the intensity of wall shear stress needed to detach monocytes from an EC monolayer. The number of monocytes attached to EC monolayer was quantitated by microscopic observation, measurement of myeloperoxidase (MPO) activity in monocyte and cellular uptake of Rose Bengal stain. The results show that the proadhesive activity of EC surface for monocytes was strongly induced by Ox-LDL and weakly modulated by N-LDL. Pretreatment of an EC monolayer with Ox-LDL (25 micrograms/ml) for 6 h induced a 2.2-fold increase in the number and an 8-fold increase in the force of monocyte binding to EC monolayer as compared to untreated control. A significant number of monocytes (4.4-times control) were able to maintain their adhesion to Ox-LDL-pretreated EC monolayer under high shear stress (30 dyn/cm2). The cell surface expression of intercellular adhesion molecule 1 (ICAM-1), but not vascular cell adhesion molecule 1 (VCAM-1), in umbilical vein EC was increased by 2.6-fold after treatment of EC with Ox-LDL (50 micrograms/ml) for 6 h compared with non-treated control. On prolonged (> 12 h) incubation, Ox-LDL (> 100 micrograms/ml) was found to have cytotoxic effect on EC as reflected by the loss of EC integrity and detachment at low shear stress. It indicates that a sublethal dose of oxidized LDL may alter vascular endothelium physiology, up-regulate expression of ICAM-1 in EC, enhance monocytes binding against shear-stress-induced detachment, and thus may contribute to atherogenesis.

Decreased expression of a particular epitope on plasma apolipoprotein B of patients with coronary artery disease

Plasma low density lipoproteins (LDL) of patients with coronary artery disease (CAD) may be qualitatively different from those of normal persons. To study the immunochemical difference in plasma LDL between CAD patients and normals, we employed competitive enzyme-linked immunosorbent assay (ELISA) using one polyclonal and five monoclonal anti-LDL antibodies to measure apolipoprotein B (apo B) epitope expression in whole plasma from 20 angiographically documented CAD patients and 7 healthy control subjects. The patient group had a significantly higher plasma concentration of apo B but showed decreased relative expression of the 4B11 epitope in plasma LDL. No significant difference in the expression of the other four epitopes was found between patients and controls. The 4B11 monoclonal anti-LDL antibody was demonstrated to inhibit the modification of native LDL by endothelial cells (EC) and to reduce subsequent uptake and degradation by J774 macrophages. In vitro oxidative modification of LDL by EC or Cu2+ was associated with a decrease in the 4B11 immunoreactivity on apo B. The results imply that plasma LDL may be somewhat oxidatively modified in vivo by vascular endothelium in patients with CAD. Competitive inhibition assay further showed that plasma LDL of CAD patients had greater ability to compete for scavenger receptor and less ability to compete for LDL receptor of J774 macrophages than those of controls. Pretreatment of EC with plasma LDL of CAD patients as compared to those of control subjects induced a significantly greater increase in U937 monocyte adhesion. In conclusion, plasma LDL of CAD patients demonstrated decreased expression of a particular apo B epitope related to scavenger receptor-binding site of EC-modified LDL and greater affinity for scavenger receptor, and caused enhanced adherence of monocytes to EC. The data support the existence of qualitative changes in plasma LDL of CAD patients.

Improvement in metabolic risk factors for coronary heart disease associated with cilazapril treatment

Patients with hypertension tend to be glucose intolerant, hyperinsulinemic, and dyslipedemic. Since all of these changes increase risk of coronary heart disease (CHD), it is important to know what effect antihypertensive treatment has on these variables. The current open-labelled, uncontrolled study was initiated in order to extend our understanding of these issues. This study was performed in 19 patients with hypertension who were started on an angiotensin converting enzyme (ACE)-inhibitor, cilazapril, with hydrochlorothiazide (HC) added if needed to control blood pressure. Plasma glucose and insulin responses to oral glucose and lipid concentrations were measured before, 26, and 52 weeks after starting treatment. Patients treated with either cilazapril (n = 9) or cilazapril+HC (n = 10) did not differ in terms of original (mean +/- SEM) blood pressure (159 +/- 5/101 +/- 1 v 156 +/- 4/103 +/- 2 mm Hg), age (53 +/- 2 v 54 +/- 2 years), sex distribution (5M:4F v 7M:3F), or body mass index (24.4 +/- 0.5 v 24.2 +/- 0.9 kg/m2). Blood pressure was also similar after 26 (137 +/- 4/88 +/- 1 v 133 +/- 3/90 +/- 1 mm Hg) and 52 (137 +/- 4/87 +/- 1 v 134 +/- 4/89 +/- 2 mm Hg) weeks of treatment. Plasma glucose and insulin responses decreased by 8 +/- 3% (P less than .05) and 25 +/- 9% (P less than .002), respectively, in cilazapril-treated patients, but did not change in those treated with cilazapril plus HC.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical experience with percutaneous intra-aortic balloon pumping in cardiogenic shock complicating acute myocardial infarction

From July 1984 to December 1987, intra-aortic balloon pumping (IABP) was attempted percutaneously to 22 patients at the ages of 37-78 with cardiogenic shock or medically refractory heart failure complicating acute myocardial infarction (CS/MRHF-AMI). There was only one failure because of severe bilateral iliofemoral atherosclerosis. Of the 21 patients undergoing IABP, 17 were in cardiogenic shock and 13 of them showed reversal of shock syndrome after 10 to 48 hours of IABP. Cardiac index increased from 1.91 +/- 0.43 to 2.45 +/- 0.43 L/min/M2 (P less than 0.005), spontaneous systolic arterial pressure rose from 79 +/- 10 to 114 +/- 19 mmHg (P = 0.0001), heart rate dropped from 111 +/- 26 to 85 +/- 13 beats/min (P = 0.0001), pulmonary artery wedge pressure decreased from 29 +/- 5 to 16 +/- 3 mmHg (P = 0.0001), and urine output increased from 7 +/- 10 to 79 +/- 22 ml/h (P = 0.0001). Twelve patients, including 4 shock-free, were subsequently weaned from balloon assistance. Of these patients, 8 (5 shock and 3 nonshock) were discharged from the hospital and followed-up for a mean period of 23 months (4 to 38 months). Of the surviving patients, 4 underwent surgical reperfusion and/or infarctectomy during balloon support (n = 1) or after weaning from IABP (n = 3). All of the 10 patients who underwent coronary angiogram were found a severe left anterior descending artery lesion. The main complication was leg ischemia, which was observed in 7 patients: 3 needed removal or replacement of balloon catheter and one required surgical removal of the thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)