Evidence for the biogenesis of more than 1,000 novel human microRNAs

BACKGROUND

MicroRNAs (miRNAs) are established regulators of development, cell identity and disease. Although nearly two thousand human miRNA genes are known and new ones are continuously discovered, no attempt has been made to gauge the total miRNA content of the human genome.

RESULTS

Employing an innovative computational method on massively pooled small RNA sequencing data, we report 2,469 novel human miRNA candidates of which 1,098 are validated by in-house and published experiments. Almost 300 candidates are robustly expressed in a neuronal cell system and are regulated during differentiation or when biogenesis factors Dicer, Drosha, DGCR8 or Ago2 are silenced. To improve expression profiling, we devised a quantitative miRNA capture system. In a kidney cell system, 400 candidates interact with DGCR8 at transcript positions that suggest miRNA hairpin recognition, and 1,000 of the new miRNA candidates interact with Ago1 or Ago2, indicating that they are directly bound by miRNA effector proteins. From kidney cell CLASH experiments, in which miRNA-target pairs are ligated and sequenced, we observe hundreds of interactions between novel miRNAs and mRNA targets. The novel miRNA candidates are specifically but lowly expressed, raising the possibility that not all may be functional. Interestingly, the majority are evolutionarily young and overrepresented in the human brain.

CONCLUSIONS

In summary, we present evidence that the complement of human miRNA genes is substantially larger than anticipated, and that more are likely to be discovered in the future as more tissues and experimental conditions are sequenced to greater depth.

The effect of diabetes and severe ischaemia on the penetration of ceftazidime into tissues of the limb

AIMS

To determine the effect of diabetes and of different degrees of ischaemia on the penetration of ceftazidime into different tissues.

METHODS

Sixteen patients (10 with diabetes mellitus) undergoing lower extremity amputation for severe ischaemia (in 12 in combination with infection), received 2000 mg ceftazidime intravenously as a bolus 30 min prior to the operation. Skin perfusion was determined by transcutaneous oxygen pressure measurements (TcPO2) on the dorsal side of the midfoot. After amputation bone, skin and muscle samples were obtained from the forefoot, midfoot and proximal tibia. Tissue and plasma concentrations were determined by HPLC. The tissue concentrations were corrected for blood contamination.

RESULTS

No differences were observed in skin, muscle or bone ceftazidime levels between diabetic and non-diabetic patients. Multiple regression analysis suggested that tissue perfusion was a major determinant of skin and bone ceftazidime concentrations, predicting 40-47% of the ceftazidime concentrations at several biopsy sites.

CONCLUSIONS

The present study suggests that tissue perfusion is the major determinant of the penetration of a third generation cephalosporin into the tissues of the ischaemic (diabetic) foot. Diabetes alone however, has no major effects upon this penetration.

Quinaprilat-induced vasodilatation in forearm vasculature of patients with essential hypertension: comparison with enalaprilat

The aim of the present study was to assess the possible differences in hemodynamic and neurohumoral responses to local ACE inhibition in the human forearm of patients with essential hypertension with either quinaprilat or enalaprilat. Forearm vascular responses to infusion of quinaprilat or enalaprilat (0.5 microg/dL/min) into the brachial artery were studied in 12 male patients with essential hypertension. The experiments were performed in a randomized, double-blind, crossover fashion. Before and during ACE inhibition, the vasoconstrictor response to four cumulative doses of angiotensin I (Ang I) was studied. Forearm blood flow was assessed using venous occlusion plethysmography. Local quinaprilat infusion induced a more rapid (even after 15 minutes; median vasodilation quinaprilat 29% vs. enalaprilat --1%, P < 0.02) and longer lasting forearm vasodilation as compared with enalaprilat. After 15 minutes of local ACE inhibition, the vasoconstrictor response to Ang I was completely blocked by both ACE inhibitors. We conclude that in patients with essential hypertension quinaprilat induces a more rapid and longer lasting vasodilatation than enalaprilat. These effects of quinaprilat are possibly related to its higher affinity for vascular ACE. On the other hand, the fact that these effects of quinaprilat were observed despite a similar degree of ACE inhibition as during enalaprilat may suggest that quinaprilat directly stimulates another vasodilatating mechanism.

Effects of brain natriuretic peptide on forearm vasculature: comparison with atrial natriuretic peptide

OBJECTIVE

The aim of the present study was to determine the vasoactive effects of brain natriuretic peptide (BNP) as compared to those of atrial natriuretic peptide (ANP) in normal man.

METHODS

Ten healthy male subjects (median age 21 (20-23) year) were studied twice. In the first study equimolar doses (1, 3, and 10 pmol/dl/min) of both BNP and ANP (in random order and double blind) were infused into the brachial artery of the non-dominant arm with a 1-h wash-out period in between. In the second study two BNP (n = 5) or ANP (n = 5) dose-response curves were performed in order to assess the repeatability of the BNP/ANP infusions. To this end, BNP and ANP were infused in the same equimolar doses as in the first protocol. Forearm blood flow (FBF) was determined by venous occlusion plethysmography before and during infusions.

RESULTS

BNP increased the FBF ratio (infused/contralateral arm) by 6%, 17%, and 48%, respectively (p < 0.05), while ANP increased the FBF ratio by 4%, 58%, and 133% (p < 0.001). The slopes of the BNP dose-response curves differed significantly from those of the ANP curves (18.1 versus 43.2; p = 0.022). No differences were observed between the repeated dose-response curves of either BNP or ANP.

CONCLUSIONS

The present data demonstrate that BNP induces a dose-dependent vasodilatation in man. On a molar basis, however, this vasodilatation is significantly less than the vasodilatation induced by ANP. These differences may be related to differences in natriuretic-peptide-receptor affinity. Furthermore, our data show that the vasoactive effects of both BNP and ANP are repeatable in time.

Endothelium-dependent vasodilatation, plasma markers of endothelial function, and adrenergic vasoconstrictor responses in type 1 diabetes under near-normoglycemic conditions

It is unknown whether and to what extent changes in various endothelial functions and adrenergic responsiveness are related to the development of microvascular complications in type 1 diabetes. Therefore, endothelium-dependent and endothelium-independent vasodilatation, endothelium-dependent hemostatic factors, and one and two adrenergic vasoconstrictor responses were determined in type 1 patients with and without microvascular complications. A total of 34 patients with type 1 diabetes were studied under euglycemic conditions on two occasions (11 without microangiopathy, 10 with proliferative and preproliferative retinopathy previously treated by laser coagulation, 13 with microalbuminuria, and 12 healthy volunteers also were studied). Forearm vascular responses to brachial artery infusions of N(G)-monomethyl-L-arginine (L-NMMA), sodium nitroprusside, acetylcholine (ACh), clonidine, and phenylephrine were determined. The ACh infusions were repeated during coinfusion of L-arginine. Furthermore, plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator antigen levels, von Willebrand factor antigen levels, tissue factor pathway inhibitor (TFPI) activity, and endothelin-1 levels were measured. No differences in endothelium-dependent or endothelium-independent vasodilatation or adrenergic constriction were observed between the diabetic patients and the healthy volunteers. In comparison to the first ACh infusion, the maximal response to repeated ACh during L-arginine administration was reduced in the diabetic patients, except in the patients with proliferative and preproliferative retinopathy previously treated by laser coagulation. In these patients, the combined infusion of L-arginine and ACh resulted in an enhanced response. TFPI activity was elevated, and PAI-1 activity was reduced in the type 1 diabetic patients. Furthermore, PAI-1 activity was positively correlated with urinary albumin excretion (r = 0.48, P < 0.01) and inversely correlated with the vasodilatory response to the highest ACh dose (r = -0.37, P < 0.05). The response to the highest ACh and L-NMMA dose were positively correlated with mean arterial blood pressure (r = 0.32, P < 0.01; r = 0.41, P < 0.01, respectively). Forearm endothelium-dependent and endothelium-independent vasodilatation and adrenergic responsiveness were unaltered in type 1 diabetic patients with and without microvascular complications. Relative to healthy control subjects, endothelium-dependent vasodilatation was depressed during a repeated ACh challenge (with L-arginine coinfusion) in the diabetic patients without complications or with microalbuminuria. In contrast, this vasodilatation was enhanced in the patients with retinopathy. Elevation of TFPI was the most consistent marker of endothelial damage of all the endothelial markers measured.

Adenosine-induced renal vasodilatation is prolonged in renal artery stenosis

OBJECTIVE

The objective of this study was to determine whether the response of renal blood flow (RBF) to adenosine infusions differs between hypertensive patients with and without renal artery stenosis (RAS).

DESIGN AND METHODS

Twenty-one hypertensive patients who underwent diagnostic angiography of the renal arteries were studied. Nine patients (median age 51 years; 45-61 interquartile ranges) were diagnosed as having essential hypertension (EH). Twelve patients (median age 52 years; 50-58) had hypertension and renal artery stenosis. In all patients three stepwise increasing doses of adenosine (1, 3 and 10 (microg/kg/min) were infused into the renal artery. RBF was measured before and during infusions by means of the 133xenon wash-out method. Arterial and venous plasma samples for renin concentration were obtained from the renal artery and renal vein. Intraarterial blood pressure and heart rate were monitored continuously.

RESULTS

Both groups were similar with respect to age, body mass index, mean arterial pressure and baseline RBF (EH: median 428; RAS 343 ml/min/100 g). Both groups showed a similar dose-related increase in RBF during adenosine infusions (normal kidneys: 9, 21 and 34% change vs baseline; stenotic kidneys: 16, 39 and 52% change vs baseline). Ten minutes after discontinuation of the adenosine infusion, RBF returned to baseline in the normal kidney group, but increased further in the stenotic kidney group (71% vs baseline; P = 0.033). Adenosine infusion did not affect the renin secretion in either group.

CONCLUSION

Both essential hypertensive patients and patients with renal artery stenosis show a dose-dependent vasodilatation following adenosine infusion. This vasodilatation is sustained after discontinuation of the adenosine infusion in patients with renal artery stenosis, suggesting a potentiated mechanism for vasodilatation induced by adenosine.

Microvascular effects of atrial natriuretic peptide (ANP) in man: studies during high and low salt diet

OBJECTIVE

Infusion of ANP in anephric dogs causes a decrease in cardiac output and a rise in peripheral vascular resistance. This reduced cardiac output is possibly related to increased resistance to venous return generated in the microcirculation by venular constriction. The aim of the present study was to evaluate in healthy volunteers the effects of low-dose ANP infusion on both conjunctival and skin microcirculation during high or low salt diet.

METHODS

ANP (7.5 ng/kg/min) and placebo were infused (i.v.) for 4 h, in random order on two separate days, in two groups of 10 healthy male volunteers each. One group was studied during high salt (ad libitum), and one group during low salt (55 mmol Na+/24 h) diet. Microvascular density and diameters of both conjunctiva and nailfold were studied using intravital videomicroscopy. Nailfold capillary red blood cell velocity (CBV) was studied using intravital videomicroscopy, and skin (thermoregulatory) blood flow (SBF) was studied using laser-Doppler fluximetry.

RESULTS

In the high salt group ANP induced a 43% reduction in basal SBF as compared to an 18% reduction by placebo (P < 0.01). Parallel to SBF, ANP significantly reduced CBV (P < 0.02). Conjunctival capillary density decreased by 5% during ANP, while it increased by 28% during placebo (P < 0.05). No such effects of ANP were observed in the low salt group. Blood pressure and heart rate were not influenced by ANP infusion in neither group.

CONCLUSION

Infusion of low doses of ANP into humans on an ad libitum salt diet results in vasoconstriction of the microcirculation, probably on the venular side. The lack of effect of ANP on the microcirculation during low salt diet may be related to a higher vascular tone prior to infusion.

Dissociation between the renal effects of angiotensin I and II in sodium-restricted normal subjects

OBJECTIVE

To determine whether the effects of angiotensin I (AngI) in humans can be explained entirely by its plasmatic conversion to angiotensin II (AngII).

METHODS

Ten healthy male volunteers on a sodium-restricted diet were studied on two separate occasions. during which, in random order, AngI or AngII was infused in increasing doses of 0.3, 1 and 3 pmol x kg-1 x min-1. Mean arterial pressure (MAP), effective renal plasma flow (ERPF), glomerular filtration rate (GER), active plasma renin concentration (APRC), AngII, aldosterone (Aldo) and catecholamines were assessed at baseline, after each dose of AngI or AngII and 30 and 60 min after discontinuation of the AngI/AngII infusion.

RESULTS

The rise in plasma AngII was significantly less during AngI infusion as compared to AngII infusion (P < 0.05). Changes in MAP, Aldo and GFR, however, were compatible during both infusions. In the kidney, on the other hand, the decrements in APRC and ERPF during AngII infusion exceeded those during AngI (P < 0.05). After cessation of either infusion. AngII concentrations, MAP, ERPF and Aldo returned to baseline levels within 1 h. Renin, however, was still significantly inhibited at that time (P < 0.05). Catecholamines remained virtually unchanged during all experiments.

CONCLUSIONS

Our data show that AngI and AngII have similar effects on blood pressure and Aldo, but they differ in their renal effects. The latter may be due to a low renal capacity to convert AngI. The prolonged inhibition of renin release after cessation of the infusions may be caused by reduced renin mRNA expression or by accumulation of AngII in the kidney.

The enhanced pressor response in type 2 diabetes is not based upon a generalized increase in vascular responsiveness

OBJECTIVE

The present study was performed to discriminate between central and peripheral effects of noradrenaline (NA) in normotensive, non-obese, type 2 diabetic patients.

METHODS

Study I: In 10 patients and 10 healthy volunteer (HV) cumulative doses of NA were infused intravenously until mean arterial pressure (MAP) rose with 20 mmHg, and subsequently the effects on the forearm blood flow (FBF) was measured. Also, the FBF response to intra-arterial NA (0.025, 0.1, 0.4 micrograms min-1) was measured. Study II: In 13 patients and 14 HV the venous constrictor response to a cumulative local infusion of NA in a dorsal hand vein was determined.

RESULTS

In study I the circulating plasma NA concentrations inducing a rise in MAP of 20 mmHg, were lower in the type 2 patients relative to the HV (p < 0.01). The relationship between changes in pressure and changes in heart rate were similar in both groups. Moreover, FBF responsiveness to intra-arterial NA was not different between the two groups. The slopes of the delta MAP/NA regression lines were correlated with basal insulin levels and relative insulin resistance in the healthy volunteers (R = 0.77, p < 0.01, and R = 0.83, p < 0.01), but not in the type 2 diabetic patients. In study II no differences were observed in the dose generating half maximum (ED50) and the maximum (Emax) response to NA between the type 2 patients and the HV.

CONCLUSIONS

Non-obese normotensive type 2 patients have an increased pressor response to NA, which is not based upon a defect in skeletal muscle resistance arterioles, peripheral veins, or a defect in the baroreceptor system. Therefore, in type 2 diabetes the noradrenergic responsiveness of other vascular beds, such as the splanchnic or renal, must be enhanced.

Acetylcholine-induced vasodilatation in the human hypertensive kidney: inhibition by muscarinic receptor antagonism

OBJECTIVE

To evaluate the vascular response of the human hypertensive kidney to endothelial stimulation with acetylcholine (ACh) and to assess whether this effect can be inhibited by the non-specific muscarinic receptor antagonist atropine.

PATIENTS AND METHODS

Three stepwise increasing doses of ACh (0.3, 1.0 and 3.0 microg/kg per min) in combination either with placebo or with 100 or 300 ng/kg per min atropine were infused into the right renal artery of 20 hypertensive patients. Renal blood flow was determined using the 133Xe wash-out technique.

RESULTS

Infusion of ACh induced a dose-dependent increase in renal blood flow (P= 0.02). Both doses of atropine attenuated the ACh-induced renal vasodilatation (P < 0.05).

CONCLUSIONS

Administration of ACh to the human hypertensive kidney induces a dose-dependent increase in renal blood flow. This effect is, at least partially, mediated by muscarinic receptors.

Impaired arterial but not venous responsiveness to nitroglycerin in non-insulin-dependent diabetes mellitus

In earlier studies, the response of the arterioles to nitroglycerin (NTG) was found to be impaired in non-insulin-dependent diabetes mellitus (NIDDM) patients. NTG has major therapeutic effects in reducing cardiac after- and preload. Thus, the vasorelaxing efficacy of a therapeutic dose of 0-4 mg of NTG sublingually (s.l.) was evaluated in the conduit femoral artery and large veins of normotensive, normoalbuminuric NIDDM patients. After NTG, the increase in the femoral artery diameter was significantly lower in the NIDDM patients than in control subjects: 0.49 (0.29-0.79) vs. 0.75 (0.47-1.00) mm respectively (median, interquartile ranges). NTG resulted in an increase of pulse wave transit time in the aorta in control subjects but not in the NIDDM patients: from 64 (60-73) to 70 (63-80) ms, P < 0.02; and from 62 (53-69) to 66 (51-72) ms, P = NS, respectively. The reduction in the venous tone of the forearm to NTG was similar in both groups. These results suggest that the response to NTG is impaired in the arterial system but not in the venous system in well-regulated NIDDM patients without diabetic complications.

Peripheral blood flow and noradrenaline responsiveness: the effect of physiological hyperinsulinemia

OBJECTIVE

Insulin seems to have vasodilator properties, but it is unclear if insulin in postprandial concentrations is a specific vasodilator of skeletal muscle resistance arterioles only or that various types of vessels are affected. The aim of the present study was to determine the direct effects and the time course of regional/local physiological hyperinsulinemia on skeletal muscle arterioles, skin blood flow and peripheral venous tone and the responsiveness of these different vascular beds to noradrenaline.

METHODS

In protocol I (n = 12) we infused insulin into the brachial artery for 180 min (3.5 mU/min) and evaluated the effects on forearm (muscle) blood flow (FBF) and skin blood flow (SBF). Furthermore, noradrenaline (0.025, 0.01 and 0.4 microgram/min) was infused (i.a.) at baseline, at 90 and 180 min after the start of insulin. In protocol 2 (n = 10) the same regional forearm hyperinsulinemia was achieved, but now the local venous responsiveness to noradrenaline (1.7-55 ng/min, at baseline and at 90 and 180 min) was measured in a dorsal hand vein. In protocol 3 we evaluated the local effects of different doses of insulin (1-100 mU/min) infused directly into hand veins preconstricted with phenylephrine.

RESULTS

Forearm hyperinsulinemia (approximately 50 mU/l) led to a significant increase in FBF after 180 min (median 26%, interq ranges 5-50, P < 0.05), while SBF was not altered. Forearm hyperinsulinemia did not affect the noradrenergic responsiveness in skeletal muscle or skin. Infused locally into hand veins only the highest dose of insulin (100 mU/min) caused a minor venodilation (7% [2.4-12.5], P < 0.05).

CONCLUSION

Regional forearm physiological hyperinsulinemia has a vasodilator effect on resistance vessels in skeletal muscle, but is slow in onset (180 min). However, skin vasculature and peripheral veins are not affected by this hyperinsulinemia.

Heterogeneous patterns of sodium excretion during sodium restriction in essential hypertensive patients

OBJECTIVE

To study the sodium excretory pattern by which sodium balance is reached.

METHODS

Ninety untreated essential hypertensives with a median age of 47 (range: 18-70 years) were admitted to a metabolic ward for 7 days and put on a sodium diet of 55 mmol/day. During these 7 days urinary excretions of sodium, potassium and creatinine were determined daily along with mean arterial pressure (MAP) and weight.

RESULTS

Changes in urinary sodium excretion were not uniform, but according to the pattern of attaining sodium balance, subjects could be divided into four groups. Group 1 (n = 31) gradually reached sodium balance, whereas group 2 (n = 10) showed an abrupt fall in sodium excretion on the third day and an extremely fluctuating sodium excretion thereafter. Group 3 (n = 32) reached sodium balance on day four, but displayed a rise in sodium excretion during the following days and group 4 (n = 17) attained sodium balance only very slowly or not at all. Compared to the other groups, group 4 lost more sodium and at the same time displayed a greater fall in blood pressure.

CONCLUSIONS

Our data suggest that there may be at least four different patterns by which sodium balance can be reached following a reduction in sodium intake. The determinants of these responses remain, however, elusive.

Peripheral haemodynamics and renal function in relation to the menstrual cycle

1. The objective of this study was to investigate whether the luteal phase of the menstrual cycle differs from the follicular phase by the development of a state of general vascular relaxation. 2. Once in the follicular and once in the luteal phase of the menstrual cycle, we measured by non-invasive techniques: arterial blood pressure (by finger blood pressure measurements), vascular tone (by pulse-wave velocity and plethysmography), blood flow to skin (by laser-Doppler), blood flow to forearm (by plethysmography) and blood flow to kidneys (by para-aminohippurate clearance), and the glomerular filtration rate (by inulin clearance). The data points obtained in the luteal phase were compared with those in the follicular phase by non-parametric tests. 3. Arterial blood pressure, vascular tone and the blood flows to the forearm and kidneys were comparable in the two phases of the menstrual cycle. In contrast, the blood flow to the skin was consistently lower, and the glomerular filtration rate higher in the luteal phase of the menstrual cycle. 4. The results of the present study do not support our hypothesis of a general vascular relaxation in the luteal phase of the menstrual cycle. The lower skin flow in the luteal phase may be an adaptation needed to ensure the higher core temperature of 0.3-0.5 degree C in the luteal phase. The higher glomerular filtration rate was in most case paralleled by a higher renal blood flow in the luteal phase. This suggests that the higher glomerular filtration rate is secondary to a selective vasorelaxation of the afferent renal arterioles.

Local 24-h hyperglycemia does not affect endothelium-dependent or -independent vasoreactivity in humans

Hyperglycemia induces regional hemodynamic changes, as suggested by animal studies. These hemodynamic changes may play an initiating role in the pathogenesis of diabetic microangiopathy. The aim of the present study was to evaluate the effects of acute local hyperglycemia for 24 h on basal human forearm muscle and skin blood flow and endothelium-dependent and -independent vasoreactivity. Local hyperglycemia (approximately 15 mM) was induced by infusion of 5% glucose into the brachial artery of the nondominant arm. In control experiments, the same individual amount of glucose was infused intravenously in the dominant arm to correct for possible systemic effects of the infused glucose. Vasoreactivity of the forearm vasculature was evaluated by local infusion of acetylcholine (ACh), sodium nitroprusside (SNP), NG-monomethyl-L-arginine (L-NMMA), and norepinephrine (NE) into the brachial artery. Regional hemodynamic measurements were performed at baseline and after 6, 12, and 24 h of local hyperglycemia. Median (with interquartile range) basal forearm (muscle) blood flow (FBF) was not influenced by the 24-h local hyperglycemia [infused-to-contralateral arm FBF ratio for glucose 1.32 (1.16-1.64) vs. control 1.54 (1.34-1.69)]. Skin microcirculatory blood flow (laser Doppler flowmetry, LDF) was not influenced by the 24-h local hyperglycemia [LDF ratio for glucose 1.00 (0.62-1.56) vs control 0.80 (0.58-1.14)]. In addition, the vasoreactivity of both muscle and skin (not shown) vasculature to ACh [percent change in FBF ratio for glucose 167% (81-263) vs. control 148% (94-211)], SNP [for glucose 486% (178-586) vs. control 293% (196-454)], L-NMMA [for glucose -36% (-56 to -22) vs. control -41% (-51 to -24)], and NE [for glucose -48% (-72 to -41) vs. control -66% (-79 to -33)] was also not affected by the local hyperglycemia. Thus, in contrast to animal studies, our results suggest that a moderate-to-severe hyperglycemia does not affect the regulation of basal blood flow or endothelium-dependent or -independent vasoreactivity in humans.

Quantitative analysis of retinal vascular changes in essential and renovascular hypertension

OBJECTIVE

To describe a quantitative analysis method for retinal vascular changes and to study retinal vascular changes in patients with mild essential or renovascular hypertension in relation to 24-h ambulatory blood pressure monitoring.

PATIENTS AND METHODS

A cross-sectional prospective study was performed in 10 patients with essential hypertension and nine with renovascular hypertension selected from the outpatient clinic (continuing medication) compared with eight age-matched normotensive control subjects. Fundal photography was performed in both eyes, preceded or succeeded (in random order) by 24-h ambulatory blood pressure monitoring. The fundus photographs were projected on a glass table and vascular morphometric variables were determined. Vascular density was evaluated using a stereological technique with a square grid overlay. The main outcome measures were arterial and venous diameters near the optic disc and at the first bifurcation, vessel length, angles of bifurcating arteries and veins, and peripheral arteriolar and venular density.

RESULTS

Both the arterial and the venous diameter was larger in the essential hypertensives and the renovascular hypertensives compared with the controls. Vascular diameter was positively correlated with mean arterial pressure during the night and with the night : day mean arterial pressure ratio (a measure of nocturnal blood pressure decline). Venular density was decreased in essential hypertension only and was not correlated with blood pressure.

CONCLUSIONS

Our quantitative retinal vascular analysis method detected an increased vascular diameter in both essential and renovascular hypertensives, which was related to night-time blood pressure and, in particular, to an attenuated nocturnal blood pressure decline. Vascular rarefaction in essential hypertension was not related to blood pressure and could influence the pathogenesis of essential hypertension.

Bone metabolism during anti-thyroid drug treatment of endogenous subclinical hyperthyroidism

OBJECTIVE

There is recent evidence that both exogenous and endogenous subclinical thyrotoxicoses are associated with decreased bone mineral density. Scanty information is available on bone metabolism in these conditions when euthyroidism is restored. We evaluated the effect of anti-thyroid drug treatment on bone metabolism in endogenous subclinical hyperthyroidism.

DESIGN

Prospective follow-up study over 2 years during treatment with methimazole, with an untreated control group.

SUBJECTS

Sixteen post-menopausal women with endogenous subclinical hyperthyroidism associated with multinodular goitre, eight of whom were treated with methimazole.

MEASUREMENTS

Serum concentrations of free T4, total T3, TSH, osteocalcin, urinary excretion of hydroxyproline and forearm bone mineral density were measured at regular intervals.

RESULTS

Significant changes in serum osteocalcin concentration or urinary hydroxyproline excretion were not observed in either group. Distal, but not proximal, forearm bone mineral density, expressed as a percentage of the base-line value, was significantly (P < 0.05) higher in the treated than in the untreated subjects in the second year of treatment.

CONCLUSION

Treatment with methimazole in post-menopausal women with endogenous subclinical hyperthyroidism associated with multinodular goitre can prevent excessive loss of bone, at least in the distal forearm.

The effects of 7-hour local hyperglycaemia on forearm macro and microcirculatory blood flow and vascular reactivity in healthy man

Animal studies suggest that hyperglycaemia directly affects local blood flow and vascular reactivity. We studied the effects of 7 h of local forearm hyperglycaemia, on forearm (muscle) and skin microcirculatory blood flow in 12 healthy men. Furthermore, the effects of this local hyperglycaemia on forearm vasoreactivity to noradrenaline were studied. Using the perfused forearm technique, a local hyperglycaemia of approximately 16 mmol/l was induced by continuous intraarterial infusion of 5% glucose. All subjects received both glucose and placebo (0.9% NaCl) infusions on two different occasions, in random order and blinded for the subjects. Forearm (muscle) blood flow and vascular reactivity to noradrenaline were measured using venous occlusion plethysmography. Skin microcirculatory blood flow was evaluated using intravital capillary microscopy (nutritive blood flow) and laser-Doppler fluxmetry (thermoregulatory blood flow). Measurements were performed at baseline, after 4 h, and after 7 h of intraarterial glucose or placebo infusion. During local glucose infusion there was a slight increase in the levels of insulin, C-peptide, systemic glucose, and blood pressure, compared to the placebo experiments. No differences were observed in forearm blood flow and laser-Doppler flux ratio (infused: contralateral arm), as well as in capillary blood cell velocity between glucose and placebo experiments. Noradrenaline produced similar reductions in forearm blood flow ratio during glucose and placebo experiments. We conclude that in contrast to animal studies, local hyperglycaemia (approximately 16 mmol/l) for 7 h does not affect forearm macro and microcirculatory blood flow or vascular reactivity to noradrenaline in man.

Venous compliance and the venodilatory effect of nitroglycerin in insulin-dependent diabetic patients with and without (incipient) nephropathy

The venous system plays a pivotal role in volume and blood pressure homeostasis. We tested the hypothesis that the visco-elastic properties of the peripheral venous system are reduced in patients with (incipient) diabetic nephropathy. Twenty-two normotensive patients with long-term insulin-dependent diabetes mellitus (IDDM), 11 without and 11 with (incipient) nephropathy (eight microalbuminuria and three proteinuria, serum creatinine below 100 mumol l-1), and 14 healthy age/sex matched controls were studied. Forearm venous compliance (VENCOMP) was determined using strain gauge plethysmography and direct intravenous pressure measurements. Furthermore, the venodilatory effect of 0.4 mg sublingual nitroglycerin (NTG) was studied. In comparison with healthy controls, VENCOMP was decreased in patients without and with (incipient) nephropathy, without any differences between the two diabetic groups: 0.059 (0.052-0.066), 0.044 (0.038-0.059) and 0.049 (0.046-0.058) ml 100 ml-1 mmHg-1, respectively (medians and interquartile ranges) (P < 0.05). No differences in the increase of forearm volume after NTG were observed: 0.34 (0.11-0.51), 0.37 (0.19-0.50) and 0.39 (0.20-0.55) ml 100 ml-1, respectively. In conclusion, the visco-elastic properties of the peripheral venous system are reduced in patients with long-term IDDM. This reduction is not related to the presence of nephropathy. No major differences were observed in NTG-induced venodilation between diabetic patients and healthy subjects.

Diurnal variations in total forearm and skin microcirculatory blood flow in man

The aim of the present study was to determine diurnal variations in total forearm and skin microcirculatory blood flow in healthy man. At six time points between 08.00 and 18.00 hours was measured: blood pressure, forearm blood flow (FBF; strain gauge plethysmography), skin thermoregulatory blood flow (LDF; laser-Doppler fluxmetry), and skin nutritive blood flow (CBV: Capillary Blood Cell Velocity; intravital capillary microscopy) in 15 healthy, fasting, and resting men. FBF increased gradually from 2.8 in the morning to 4.3 ml 100 ml min-1 in the afternoon (p < 0.001). In contrast, LDF decreased, predominantly in the morning, from 18.3 at 09.00 hours to 13.1 at 12.00 hours and to 12.1 perfusion units at 17.30 hours (p < 0.001). However, performing the same protocol starting in the afternoon resulted in a similar initial decrease in LDF, suggesting an acclimatization phenomenon. Although not statistically significant, the decrease in CBV showed a similar pattern as compared to LDF. Blood pressure did not change. In conclusion, forearm blood flow increased during the day, probably due to diurnal variation in muscle flow. The initial decrease we observed in skin thermoregulatory blood flow is probably not related to diurnal variation but due to long-term acclimatization to the experimental conditions. These data suggest different regulatory mechanisms for the different vascular beds studied. Measurements of forearm blood flow should preferably be performed at the same time of day, and skin microcirculatory haemodynamic measurements should be performed after a standard period of acclimatization.

Peripheral macro- and microcirculation in short-term insulin-dependent diabetes mellitus: the role of prostaglandins in early haemodynamic changes

To determine whether vasodilator prostaglandins are involved in the peripheral hyperperfusion observed in patients with short-term insulin-dependent diabetes mellitus (IDDM), forearm and skin blood flow were studied before and after cyclooxygenase inhibition. Skin nutritive (CBV: capillary blood-cell velocity) and thermoregulatory (LDF: laser-Doppler fluxmetry), and forearm (muscle) blood flow (FBF) were measured before and after 500 mg acetylsalicylic acid (ASA) infused intravenously in 14 short-term IDDM patients and 22 healthy control subjects. In the IDDM patients, baseline LDF (median: 27 (19-35); interquartile range) vs. 17 (15-23) pu) and FBF (3.4 (2.5-4.1) vs. 2.6 (2.2-2.9) ml 100 ml-1 min-1) were increased, while CBV (0.70 (0.40-1.33) vs. 0.69 (0.41-0.96) mm s-1) was unchanged compared to healthy controls. ASA infusion had similar effects on baseline CBV, LDF, and FBF in patients and controls. In eight of the control subjects the role of prostaglandins in the regulation of basal peripheral blood flow was studied before and after ASA and placebo infusion. The changes in baseline CBV, LDF, and FBF were similar after ASA and placebo infusion in healthy controls. In conclusion, in short-term IDDM patients, increased skin thermoregulatory and forearm (muscle) blood flow are probably not related to vasodilator prostaglandins. Furthermore, prostaglandins are not likely to be involved in regulating basal peripheral blood flow in healthy man.

Acute effects of local hyperglycaemia on peripheral blood flow in man

To determine whether local hyperglycaemia affects peripheral blood flow in man, total forearm and skin microcirculatory blood flow were studied in healthy subjects before, during, and after a 1-h infusion of different concentrations of glucose or mannitol in the brachial artery. Mild or high forearm hyperglycaemia induced by 5% glucose infusion (approximately 10 mmol l-1 and approximately 18 mol l-1, respectively) did not induce any changes in forearm muscle or skin blood flow. However, mild forearm hyperglycaemia (approximately 8 mmol l-1), induced by 20% glucose infusion, acutely increased forearm blood flow, decreased forearm vascular resistance, but did not change skin blood flow. Twenty percent Mannitol infusion, as an osmotic control, did not result in any changes. We conclude that intra-arterial administration of 5% glucose does not acutely affect peripheral blood flow. The glucose-related effect induced by 20% infusion is probably due to marked hyperglycaemia at the catheter tip.

Skin blood cell flux in insulin-dependent diabetic subjects in relation to retinopathy or incipient nephropathy

We studied the relationship of retinal and/or renal microvascular complications and duration of disease with altered finger skin microcirculation in insulin-dependent diabetic (IDDM) subjects. Short-term and long-term IDDM subjects without complications or with proliferative retinopathy or incipient nephropathy were investigated with laser-Doppler fluxmetry. An increased resting flux in skin microcirculation was found in short-term (median: 34 perfusion units, PU) and uncomplicated long-term IDDM subjects (25 PU) as compared with age-matched healthy controls (18 PU), which suggests a generalized dilatation of the microcirculation throughout the body. In long-term IDDM subjects with retinopathy we also observed an increased resting flux (37 PU), but in subjects with incipient nephropathy resting flux was decreased (17 PU) relative to the other diabetic subjects, to a level not different from the healthy control group. Post-occlusive hyperaemic peak flux was decreased in patients with incipient nephropathy relative to the other diabetic patients, which suggests a defect in maximal arteriolar vasodilatation. No differences were found between the groups in the venoarteriolar reflex during venous occlusion. In conclusion, IDDM patients demonstrated increased red blood cell flux. However, with the occurrence of incipient nephropathy the resting flux and the maximal post-occlusive vasodilatation decreased, which suggests that development of nephropathic changes in diabetes is representative of a more generalized alternation of microvascular flow regulation. Local neurogenic microvascular control appears to be unaffected in these patients.

Regulation of cyclic-AMP synthesis in amphibian melanotrope cells through catecholamine and GABA receptors

Catecholamines and GABA are neurotransmitters involved in the regulation of release of pro-opiomelanocortin (POMC) derived peptides from the neurointermediate lobe of Xenopus laevis. The present study concerns the relation of these neurotransmitters to the adenylate cyclase system of the melanotrope cell. During in vitro incubation of isolated melanotrope cells it was found that dopamine, adrenaline and LY 171555 induced inhibition of forskolin-stimulated cAMP production and concomitantly inhibited MSH release. Activation of the GABAb receptors by baclofen also induced inhibition of cAMP production and alpha MSH secretion. Activation of the GABAa receptors evoked stimulation of cAMP production, while alpha MSH release was slightly inhibited, indicating that the GABAa mechanism may prove to be complex. A dual regulation through two subtypes of this receptor might be involved, one stimulating release through the adenylate cyclase system, while the other would inhibit secretion.