Protein kinase C and the development of diabetic vascular complications

Hyperglycemic control in diabetes is key to preventing the development and progression of vascular complications such as retinopathy, nephropathy and neuropathy. Increased activation of the diacylglycerol (DAG)-protein kinase C (PKC) signal transduction pathway has been identified in vascular tissues from diabetic animals, and in vascular cells exposed to elevated glucose. Vascular abnormalities associated with glucose-induced PKC activation leading to increased synthesis of DAG include altered vascular blood flow, extracellular matrix deposition, basement membrane thickening, increased permeability and neovascularization. Preferential activation of the PKCbeta isoform by elevated glucose is reported to occur in a variety of vascular tissues. This has lead to the development of LY333531, a PKCbeta isoform specific inhibitor, which has shown potential in animal models to be an orally effective and nontoxic therapy able to produce significant improvements in diabetic retinopathy, nephropathy, neuropathy and cardiac dysfunction. Additionally, the antioxidant vitamin E has been identified as an inhibitor of the DAG-PKC pathway, and shows promise in reducing vascular complications in animal models of diabetes. Given the overwhelming evidence indicating a role for PKC activation in contributing to the development of diabetic vascular complications, pharmacological therapies that can modulate this pathway, particularly with PKC isoform selectivity, show great promise for treatment of vascular complications, even in the presence of hyperglycemia.

Identification of PKC-isoform-specific biological actions using pharmacological approaches

The protein kinase C (PKC) family consists of at least 12 isoforms that possess distinct differences in structure, substrate requirement, expression and localization. To date, identification of the physiological function of individual PKC isoforms has been restricted by the availability of few agents that inhibit or activate the isoforms with specificity. More recent approaches that are used to modulate PKC isoforms include oligonucleotide antisense technology, and peptide fragments to either inhibit or promote translocation of PKC isoforms to specific anchoring proteins. In this review, several currently available inhibitors and activators of PKC that display varying degrees of selectivity for the PKC isoforms will be discussed.

Insulin reversal of impaired nitrergic transmission in the anococcygeus muscle from diabetic rats

The aim of this study was to investigate whether insulin could reverse the impairment in nitrergic neurotransmission in the anococcygeus muscle from streptozotocin-induced diabetic rats. Relaxations to nitrergic nerve stimulation and sodium nitroprusside were significantly reduced in precontracted muscles from 8- and 4-week diabetic rats compared to the corresponding control rats. Treatment of diabetic rats with Lente insulin (1-12 units/day s.c.) for the final 4 weeks of the 8-week diabetes duration reversed the reductions, but treatment of diabetic rats with insulin for the last week only did not. The impairment of relaxations was also not altered by in vitro exposure of muscles from 8-week diabetic rats to soluble insulin (0.02 units/ml, 2 h). The findings suggest that in vivo insulin treatment can reverse the existing diabetes-induced impairment of nitrergic transmission in rat anococcygeus muscle. However, short-term treatment with insulin, either in vivo or in vitro, does not reverse the impairment.

The effects of diabetes on nitric oxide-mediated responses in rat corpus cavernosum

Nitric oxide (NO)-mediated responses were investigated in corpora cavernosa isolated from 8-week diabetic rats. Relaxations to field stimulation were abolished by N(G)-nitro-L-arginine (NOARG, 100 microM). Responses to stimulation and sodium nitroprusside were reduced in tissues from diabetic rats compared to control rats, when data were expressed as g tension, but not when expressed as g/g tissue. The endothelium-dependent vasodilator, acetylcholine, failed to relax tissues. Stimulation-induced contractions were smaller in the diabetic group compared to the control group when data were expressed as g tension, but not g/g tissue. Contractions were enhanced by NOARG, and inhibited by acetylcholine (300 microM), by a similar degree in both groups. NOARG reduced the inhibitory effect of acetylcholine in tissues from control, but not diabetic rats. The results suggest diabetes caused a general impairment in responsiveness of rat corpus cavernosum, which may be a consequence of tissue weight change. A role for endothelium-dependent NO could not be identified; however, NO-mediated modulation of noradrenergic transmission by acetylcholine, may be defective in diabetes.

Diabetes does not alter the activity and localisation of nitric oxide synthase in the rat anococcygeus muscle

Functional studies have revealed diabetes specifically impairs smooth muscle reactivity to nitric oxide in the rat anococcygeus muscle. The present study was conducted to examine whether concurrent prejunctional defects in nitrergic neurotransmission exist in anococcygeus muscles from diabetic rats. Nitric oxide synthase (NOS) activity was assessed by the conversion of 3H-L-arginine to 3H-L-citrulline in homogenates of anococcygeus muscles obtained from 8-week diabetic rats and control rats. NOS activity measured in all tissue samples was dependent on the presence of calcium (2 mM), NADPH (1 mM), tetrahydrobiopterin (100 microM) and flavin adenine dinucleotide (10 microM); however, removal of calmodulin (50 U/ml) did not reduce L-citrulline production. Both N(G)-nitro-L-arginine (100 microM) and N(G)-nitro-L-arginine methyl ester (100 microM) produced significant inhibition of enzyme activity. NOS activity measured in tissue samples from diabetic rats (369.6 +/- 75.9 fmol L-citrulline/mg protein) did not significantly differ from that measured in samples from control rats (423.9 +/- 110.6 fmol L-citrulline/mg protein). However, NOS activity measured after removal of the cofactor tetrahydrobiopterin, was significantly greater in samples from control rats than that from the diabetic group. NOS-immunoreactive and NADPH-diaphorase reactive nerve terminals were found to be sparsely distributed throughout longitudinal sections or whole mounts of anococcygeus muscles from both control and diabetic rats. Quantification of NADPH-diaphorase positive fibres intersecting transects of whole tissue mounts, revealed no significant difference in fibre number between the treatment groups. All NOS-immunoreactive fibres also showed vasoactive-intestinal-polypeptide immunoreactivity. In conclusion, the findings together provide no evidence to indicate that diabetes can induce prejunctional changes in NOS activity or localisation, concurrent with the reported postjunctional impairment in smooth muscle reactivity to nitric oxide, in the rat anococcygeus muscle.

The aldose reductase inhibitor sorbinil does not prevent the impairment in nitric oxide-mediated neurotransmission in anococcygeus muscle from diabetic rats

This study investigated whether increased polyol pathway activity could contribute to alterations in nitrergic neurotransmission in anococcygeus muscles from 8-week diabetic rats. In the presence of guanethidine (10-30 microM) and clonidine (0.01-0.05 microM), relaxations obtained to nitrergic nerve stimulation (0.5-5 Hz, 10-s train), to sodium nitroprusside (5-500 nM) and to nitric oxide (0.1-3 microM) were significantly reduced in muscles from diabetic rats compared to responses from control rats. Treatment of diabetic rats with the aldose reductase inhibitor sorbinil (42 mg/kg per day via feed for 8 weeks) did not affect impaired reactivity to nitrergic nerve stimulation, sodium nitroprusside or nitric oxide. The results suggest increased polyol pathway activity does not contribute to the alterations in nitrergic neurotransmission in anococcygeus muscles from diabetic rats.

Effect of diabetes and elevated glucose on nitric oxide-mediated neurotransmission in rat anococcygeus muscle

1. Nitric oxide (NO)-mediated neurotransmission is impaired in anococcygeus muscle from 8-week streptozotocin-induced diabetic rats. This study investigated the effects of insulin treatment, and the duration of diabetes on this impairment. In addition, the effect of in vitro exposure to elevated glucose has been investigated on NO-mediated relaxations, in muscles from untreated rats. 2. Relaxant responses to field stimulation (0.5-5 Hz, 10s train), sodium nitroprusside (SNP; 5 and 10 nM) and NO (1 and 3 microM) were significantly impaired in anococcygeus muscles from 8-week diabetic rats, compared to responses from control rats. Insulin treatment (5 u Lente day-1, s.c.) of diabetic rats prevented the development of this impairment. 3. Consistent with findings in 8-week diabetic rats, relaxation induced by field stimulation, SNP and NO were attenuated in tissues from 2-week and 4-week diabetic rats compared to corresponding control responses, whereas relaxations to papaverine (3 and 10 microM) were not reduced. In contrast, diabetes of 3-days duration did not affect relaxations to field stimulation, SNP or NO. 4. Incubation of anococcygeus muscles from untreated rats in medium containing elevated glucose (44.1 mM) for 6 h, significantly impaired relaxations to field stimulation compared to responses obtained after normal glucose (11.1 mM) incubation. Relaxations to SNP and to NO were not affected by 6 h exposure to elevated glucose. Similarly, incubation in hyperosmolar solutions containing mannose or sucrose for 6 h, impaired relaxations to field stimulation, but not to SNP or NO. 5. The results indicate that the diabetes-induced impairment of NO-mediated neurotransmission in the rat anococcygeus muscle develops between 3 days and 2 weeks after the induction of diabetes with streptozotocin. Prevention of the impairment by insulin treatment suggests that it is specific for the diabetic state. In addition, the impairment may be related to hyperglycaemia and the consequent rise in osmolarity, since in vitro exposure to high glucose as well as to other hyperosmolar media impaired NO-mediated relaxations to field stimulation.

Effect of aminoguanidine on the impaired nitric oxide-mediated neurotransmission in anococcygeus muscle from diabetic rats

The contribution of advanced glycation end-product (AGE) formation to alterations in nitrergic neurotransmission caused by 8-week streptozotocin-induced diabetes has been examined in the rat anococcygeus muscle. Relaxant responses to nitrergic nerve stimulation (0.5-5 Hz, 10-sec train), to nitric oxide (NO; 0.1-3 microM), to the NO donor, sodium nitroprusside (SNP; 5-500 nM), and to the cell-permeable analogue of cyclic guanosine monophosphate (cGMP), 8-bromo-cGMP (15 and 30 microM), were significantly smaller in muscles from diabetic rats than from control rats. Pretreatment with aminoguanidine hemisulphate (1 milligram drinking water) to inhibit AGE formation, did not alter the relaxant responses to nitrergic nerve stimulation, NO or SNP in tissues from control rats, or responses to NO or SNP in tissues from diabetic rats, however relaxations to nitrergic nerve stimulation were further reduced in tissues from diabetic rats. In anococcygeus muscles from untreated animals, a 20-min exposure to aminoguanidine (1 mM) in vitro had no effect on relaxations to nitrergic nerve stimulation. The results suggest that diabetes impairs nitrergic transmission in the rat anococcygeus at least partly through alterations in the cGMP-relaxation pathway. The impaired neurotransmission does not appear to be related to the formation of AGEs.

Nitric oxide-mediated neurotransmission is attenuated in the anococcygeus muscle from diabetic rats

The effect of STZ-induced diabetes of 8-weeks duration was examined on nitric oxide-mediated neurotransmission in the rat anococcygeus muscle. In the presence of noradrenergic blockade and raised tissue tone, relaxant response to nerve stimulation (0.5-5 Hz, for 10 s), sodium nitroprusside (5 and 10 nmol/l) and nitric oxide (1 and 3 mumol/l) were significantly reduced in anococcygeus muscles from diabetic rats compared to responses from control rats (p < 0.05). In contrast, relaxations to papaverine (3 and 10 mumol/l) were not reduced in tissues from diabetic rats. The nitric oxide synthesis inhibitor NOLA (100 mumol/l) abolished relaxant responses to nerve stimulation but had no effect on responses to any of the relaxant agents used. Exposure to NOLA at 10 mumol/l reduced stimulation-induced relaxations; this reduction was significantly greater in tissues from the diabetic group than from the control group (p < 0.05), probably as a consequence of the smaller relaxant responses in muscles from diabetic rats. Contractile responses to nerve stimulation (1-10 Hz, for 10 s), but not noradrenaline (0.03-30 mumol/l), were significantly greater in anococcygeus muscles from diabetic rats than from control rats (p < 0.05). NOLA (100 mumol/l) significantly enhanced stimulation-induced contractions (p < 0.05), however the enhancement was significantly less in tissues from diabetic rats (p < 0.05). The results suggest that STZ-induced diabetes impairs smooth muscle reactivity to nitric oxide in the rat anococcygeus muscle.