Genetic predisposition to albuminuria is associated with increased arterial stiffness: role of elastin

BACKGROUND AND PURPOSE

The Munich Wistar Frömter (MWF) rat strain represents an experimental model to study cardiovascular alterations under conditions of progressive albuminuria. The aim of this study was to evaluate the association between genetic predisposition to albuminuria and the development of arterial stiffness and/or vascular remodelling.

EXPERIMENTAL APPROACH

Experiments were performed in mesenteric arteries from 12-week-old MWF, Wistar Kyoto (WKY) and consomic MWF-6(SHR) and MWF-8(SHR) rats in which chromosomes 6 or 8 associated with albuminuria from MWF were replaced by the respective chromosome from spontaneously hypertensive rats (SHR).

KEY RESULTS

Incremental distensibility, wall stress and strain were reduced, and arterial stiffness was significantly increased in albuminuric MWF compared with WKY. Albuminuria suppression in both consomic strains was associated with lower β-values in MWF-8(SHR) and MWF-6(SHR) compared with MWF. Moreover, elastin content was significantly lower in MWF external elastic lamina compared with WKY and both consomic strains. In addition, a reduction in arterial external and internal diameter and cross-sectional area was detected in MWF compared with WKY, thus exhibiting an inward hypotrophic remodelling. However, these alterations remained unchanged in both consomic strains.

CONCLUSION AND IMPLICATIONS

These data demonstrate that albuminuria in MWF is associated with increased arterial stiffness due to a reduction of elastin content in the external elastic lamina. Moreover, inward hypotrophic remodelling in MWF is not directly associated with albuminuria. In contrast, we demonstrated that two major genetic loci affect both the development of albuminuria and arterial stiffness, thus linking albuminuria and impairment of mechanical properties of resistance arteries.

Comparative expression analysis of the renin-angiotensin system components between white and brown perivascular adipose tissue

Recent studies have demonstrated that the rat adipose tissue expresses some of the components necessary for the production of angiotensin II (Ang II) and the receptors mediating its actions. The aim of this work is to characterize the expression of the renin-angiotensin system (RAS) components in perivascular adipose tissue and to assess differences in the expression pattern depending on the vascular bed and type of adipose tissue. We analyzed Ang I and Ang II levels as well as mRNA levels of RAS components by a quantitative RT-PCR method in periaortic (PAT) and mesenteric adipose tissue (MAT) of 3-month-old male Wistar-Kyoto rats. PAT was identified as brown adipose tissue expressing uncoupling protein-1 (UCP-1). It had smaller adipocytes than those from MAT, which was identified as white adipose tissue. All RAS components, except renin, were detected in both PAT and MAT. Levels of expression of angiotensinogen, Ang-converting enzyme (ACE), and ACE2 were similar between PAT and MAT. Renin receptor expression was five times higher, whereas expression of chymase, AT(1a), and AT(2) receptors were significantly lower in PAT compared with MAT respectively. In addition, three isoforms of the AT(1a) receptor were found in perivascular adipose tissue. The AT(1b) receptor was found at very a low expression level. Ang II levels were higher in MAT with no differences between tissues in Ang I. The results show that the RAS is differentially expressed in white and brown perivascular adipose tissues implicating a different role for the system depending on the vascular bed and the type of adipose tissue.

Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer

OBJECTIVES

To determine the efficacy of a three-fold reduced dose (RD, 27 mg) of intravesical bacille Calmette-Guérin (BCG) against the standard dose (81 mg) in patients with superficial bladder cancer, assessing recurrence, progression and differences in toxicity.

PATIENTS AND METHODS

Five hundred patients with superficial bladder cancer (Ta, T1, Tis) were enrolled and randomly assigned to be treated after transurethral resection of all visible lesions with intravesical BCG Connaught strain (weekly x six and thereafter fortnightly x six) either with the standard or RD instillation.

RESULTS

All but one of the 500 patients were evaluable for efficacy and toxicity (252 in the standard arm and 247 in the RD arm). The median follow-up was 69 months (maximum 104); 71 (28%) patients in the standard arm and 76 (31%) in the RD arm developed recurrences; the median time to recurrence has not yet been attained, but at 5 years the mean (sd) percentage of recurrence-free patients was 70.5 (3.12) and 70.4 (3.1) for the standard and RD arms, respectively. In patients presenting with multifocal tumours, the standard dose was more effective against recurrences than the RD (P=0.0151). In those with G3 and high-risk tumours overall, the superiority of the standard dose was marginal (P=0.060 and P=0.082). Twenty-nine (11.5%) tumours in the standard arm and 33 (13.3%) in the RD arm progressed to invasive disease; the median time to progression has not yet been attained, but the percentage of progression-free patients at 5 years was 88.8 (2.23) and 86.9 (2.31) for the standard and RD arms, respectively. The standard dose was more effective than the RD against progression only in patients with multifocal disease (P=0.048). Twelve (4.8%) cystectomies were performed in the standard and 15 (6.1%) in the RD arm. Currently, 106 (21.2%) patients have died, but only 38 (7.6%) from bladder cancer, i.e. 20 (7.9%) in the standard and 18 (7.5%) in RD arm. Overall the disease-specific death rate was lower for those patients who completed the scheduled treatment. The cause-specific survival at 5 years did not differ between the arms (P=0.76) but there was a trend toward better cause-specific survival for patients with multifocal tumours in the standard arm. Toxicity differed between the arms, significantly more patients having no toxicity in the RD arm, and fewer having delayed instillations or withdrawing. However, severe systemic toxicity occurred even in patients treated with the RD, in a similar proportion to those receiving the standard dose.

CONCLUSION

Overall, the RD gave similar results for recurrence and progression but with significantly less toxicity. However, patients with multifocal tumours fared better with the standard dose and there was a trend towards better recurrence rates in patients with high-risk tumours. We recommend continuing to use the standard dose for high-risk tumours, while we consider the reduced dose safe and effective for intermediate-risk lesions and for maintenance schedules.

Detection and Mapping of Decoupled Stellar and Ionized Gas Structures in the Ultraluminous Infrared Galaxy IRAS 12112+0305

Integral field optical spectroscopy with the INTEGRAL fiber-fed system and Hubble Space Telescope optical imaging are used to map the complex stellar and warm ionized gas structure in the ultraluminous infrared galaxy IRAS 12112+0305. Images reconstructed from wavelength-delimited extractions of the integral field spectra reveal that the observed ionized gas distribution is decoupled from the stellar main body of the galaxy, with the dominant continuum and emission-line regions separated by projected distances of up to 7.5 kpc. The two optical nuclei are detected as apparently faint emission-line regions, and their optical properties are consistent with being dust-enshrouded weak [O i] LINERs. The brightest emission-line region is associated with a faint (mI=20.4), giant H ii region of 600 pc diameter, in which a young ( approximately 5 Myr) massive cluster of about 2x107 M middle dot in circle dominates the ionization. Internal reddening toward the line-emitting regions and the optical nuclei ranges from 1 to 8 mag in the visual. Taking the reddening into account, the overall star formation in IRAS 12112+0305 is dominated by starbursts associated with the two nuclei and corresponds to a star formation rate of 80 M middle dot in circle yr-1.

Integral Field Spectroscopy of Markarian 273: Mapping High-Velocity Gas Flows and an Off-Nucleus Seyfert 2 Nebula

Integral field optical spectroscopy with the INTEGRAL fiber-based system is used to map the extended ionized regions and gas flows in Mrk 273, one of the closest ultraluminous infrared galaxies. The Hbeta and [O iii] lambda5007 maps show the presence of two distinct regions separated by 4&arcsec; (3.1 kpc) along position angle (P.A.) 240 degrees. The northeastern region coincides with the optical nucleus of the galaxy and shows the spectral characteristics of LINERs. The southwestern region is dominated by [O iii] emission and is classified as a Seyfert 2. Therefore, in the optical, Mrk 273 is an ultraluminous infrared galaxy with a LINER nucleus and an extended off-nucleus Seyfert 2 nebula. The kinematics of the [O iii] ionized gas shows (1) the presence of highly disturbed gas in the regions around the LINER nucleus, (2) a high-velocity gas flow with a peak-to-peak amplitude of 2.4x103 km s-1, and (3) quiescent gas in the outer regions (at 3 kpc). We hypothesize that the high-velocity flow is the starburst-driven superwind generated in an optically obscured nuclear starburst and that the quiescent gas is directly ionized by a nuclear source, similar to the ionization cones typically seen in Seyfert galaxies.

Discovery of a low-mass brown dwarf companion of the young nearby star G 196-3

A substellar-mass object in orbit at about 300 astronomical units from the young low-mass star G 196-3 was detected by direct imaging. Optical and infrared photometry and low- and intermediate-resolution spectroscopy of the faint companion, hereafter referred to as G 196-3B, confirm its cool atmosphere and allow its mass to be estimated at 25-10+15 Jupiter masses. The separation between the objects and their mass ratio suggest the fragmentation of a collapsing cloud as the most likely origin for G 196-3B, but alternatively it could have originated from a protoplanetary disc that has been dissipated. Whatever the formation process was, the young age of the primary star (about 100 million years) demonstrates that substellar companions can form on short time scales.

Endothelial modulation of ouabain-induced contraction and sodium pump activity in aortas of normotensive Wistar-Kyoto and spontaneously hypertensive rats

The influence of vascular endothelium on ouabain-induced contractions and sodium pump activity in aortic segments of Wistar-Kyoto (WKY) and spontaneously hypertensive rat (SHR) was analyzed. De-endothelialization increased and reduced ouabain-induced contractions in WKY and SHR segments, respectively. The effects of de-endothelialization were not reproduced by pretreatment of the segments with NG-nitro-L-arginine methyl ester, indomethacin, or 5, 8, 11, 14-eicosatetraenoic acid, acetyl salicylic acid, dazoxiben, phosphoramidon, BQ-123, or superoxide dismutase. Bioassay experiments suggest that ouabain releases a diffusible factor from endothelial cells that inhibits or facilitates digitalis-induced contractions in WKY and SHR segments, respectively. In a potassium-free solution, potassium-induced relaxation in segments of both strains was abolished by ouabain in de-endothelialized aortas and reduced in intact ones. Ouabain-sensitive 86Rb+ uptake was significantly reduced by de-endothelialization both in WKY and in SHR. These results suggest that the vascular endothelium of WKY and SHR aortas releases a diffusible factor that stimulates the sodium pump and/or protects it from ouabain blockade. Ouabain also releases a diffusible endothelium-derived factor in SHR aortas that facilitates ouabain-induced contractions.

Influence of age on the relaxation induced by nifedipine in aorta from spontaneously hypertensive and Wistar Kyoto rats

1. Nifedipine induces relaxation in aortic segments from Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR) of 5-week-, 3-month-, 6-month- and 1.5-year-old precontracted with 50 mM K+ or 0.1 microM noradrenaline (NA). 2. In WKY rat segments precontracted with K+, nifedipine relaxation was reduced at 1.5 years. However, in SHR segments, the greatest relaxation was observed at 1.5 years. The relaxation elicited by nifedipine in segments from WKY of 6-month and 1.5-year-old precontracted with NA was higher than that reached at 5-week- and 3-month-old. However, the relaxation induced in SHR of 6-month and 1.5-year-old was only higher than that obtained at 5-week-old. 3. Relaxations elicited by nifedipine in segments from WKY precontracted with K+ were smaller than those observed in age-matched SHR segments. 4. The endothelium positively and negatively modulates the relaxation to nifedipine in segments from SHR and WKY rats of different ages precontracted with K+, respectively. However, in segments of both strain precontracted with NA, endothelium removal did not alter the relaxations obtained at different ages. 5. These results suggest that the relaxation elicited by nifedipine: (1) depends on the strain, with a tendency to be greater in the hypertensive strain; (2) is negatively and positively modulated by endothelium in WKY and SHR, respectively, and (3) is influenced by age, and this influence depends on both the contractile agent and the strain.

Functional vascular renin-angiotensin system in hypertensive transgenic rats for the mouse renin gene Ren-2

1. Isolated aortic segments from transgenic rats for the mouse renin gene Ren-2 were more sensitive than those from control Sprague-Dawley ones to the vasoconstrictions induced by angiotensin II and to the potentiation of norepinephrine contractions by this peptide. 2. In transgenic, but not in control aorta, pretreatment with angiotensinogen potentiated norepinephrine-induced vasoconstrictions, this effect being abolished by captopril. 3. These results suggest that in the aorta of transgenic rats there is a higher functional tissue renin-angiotensin system that potentiates the vascular reactivity to norepinephrine.

Norepinephrine-induced relaxations in rat aorta mediated by endothelial beta adrenoceptors. Impairment by ageing and hypertension

The objective of the present work has been to analyze the influence of endothelium, ageing and hypertension in the norepinephrine (NE)-induced responses. For this purpose we used aortic rings from spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) rats of different ages. In rings with endothelium from 5-week-old WKY, cumulative addition of NE (0.01 and 0.1 microM) caused concentration-dependent contractions, whereas higher concentrations (1 and 10 microM) induced concentration-dependent relaxations. In 5-week-old SHR and 3-month-old WKY rats, these relaxant responses were observed only at 10 microM NE, and they disappeared in older animals from both strains. In endothelium denuded rings, NE induced only contractions, which were similar in WKY rats of different ages, but significantly increased in 6- and 12-month-old SHR. In both strains, the endothelium-dependent relaxant responses to NE were abolished by NG-nitro-L-arginine methyl ester and propranolol, but not modified by yohimbine or ouabain. Isoproterenol (0.01-10 microM) induced concentration-dependent vasodilation in rings from 5-week-old rats of both strains, precontracted with 1 microM NE. Isoproterenol-elicited responses were reduced by endothelium removal or by 0.1 mM NG-nitro-L-arginine methyl ester and abolished by 1 microM propranolol. These results suggest that: 1) in the aorta from young WKY and prehypertensive SHR rats, NE induces vasodilations mediated by activation of endothelial beta adrenoceptors and release of nitric oxide; 2) these responses are impaired during ageing and hypertension; and 3) there is an important negative endothelial modulation of NE-induced contraction in adult SHR rats.

Neurogenic component of ouabain-evoked contractions is modulated by the endothelium

The influence of endothelium on the neurogenic component of ouabain-induced contractions in isolated perfused guinea pig carotid arteries was analyzed. Ouabain (0.1 mumol/L to 0.1 mmol/L) evoked concentration-dependent increases of perfusion pressure. Phentolamine (0.3 to 10 mumol/L) and prazosin (30 nmol/L to 10 mumol/L) (nonselective antagonist of alpha-adrenergic receptors and selective antagonist of alpha 1-adrenergic receptors, respectively) induced a concentration-dependent relaxation in segments precontracted with ouabain (0.1 mmol/L). When the arteries were preincubated with those blockers (both at 3 mumol/L) or the animals were pretreated with reserpine, the contractions to the glycoside were diminished, indicating that they are partially mediated by norepinephrine release from adrenergic nerve endings. De-endothelialization abolished the effect of adrenergic blockade on ouabain-induced contractions. On the other hand, de-endothelialization did not modify significantly the effect of the adrenergic blockade on norepinephrine-induced contractions. The nitric oxide blocker oxyhemoglobin, at concentrations (10 mumol/L) that abolished endothelium-dependent relaxations induced by 3 mumol/L acetylcholine; or the cyclooxygenase blocker indomethacin (10 mumol/L) did not modify the relaxation caused by phentolamine. In bioassay experiments, 30 mumol/L phentolamine induced a relaxation on the ouabain-elicited contraction only when the glycoside was added through a donor segment with endothelium. Ouabain-induced tritiated norepinephrine release was significantly reduced by the removal of endothelium but not by 1 mumol/L oxyhemoglobin or 1 mumol/L indomethacin. These results suggest that the endothelium modulates the neurogenic component involved in contractions evoked by the glycoside by a diffusible factor (or factors) whose nature is unknown; however, the factor is neither nitric oxide nor a cyclooxygenase-related compound.

Interference of glycosylated human hemoglobin with endothelium-dependent responses

BACKGROUND

Hypertension and other vascular diseases are more prevalent in diabetic patients than in the general population. In humans and in several animal models of diabetes, a disturbance of endothelium-dependent responses has been shown. Oxyhemoglobin is one of the most known modulators of these endothelium-dependent responses. We postulate that high levels of plasmatic glycosylated hemoglobin, a frequent profile in diabetic patients, may be the cause of the disturbance in endothelium-dependent relaxation and/or contraction.

METHODS AND RESULTS

Endothelium-dependent responses to acetylcholine and several alpha-adrenergic agonists (norepinephrine, methoxamine, and clonidine) were tested in segments of rat aorta. Experiments were carried out in control segments and in those preincubated with several concentrations of nonglycosylated, low-glycosylated (7.3%), and high-glycosylated (14%) human hemoglobin. Low concentrations of high-glycosylated human hemoglobin (1 to 100 nmol/L) but not of low- or nonglycosylated hemoglobin, inhibited endothelium-dependent relaxation caused by acetylcholine in intact vessels. The same effect was observed on relaxations caused by nitric oxide in denuded ones. High-glycosylated human hemoglobin (10 nmol/L) induced an increase in norepinephrine-evoked contraction in intact vessels; this latter effect was also shown in vessels contracted with methoxamine but not with clonidine. De-endothelialization of the vascular segments blunted these effects of high-glycosylated human hemoglobin.

CONCLUSIONS

High glycosylation of human hemoglobin impairs endothelium-mediated vasoactive responses and may play a pathophysiological role in producing hypertension and vascular diseases in diabetic patients.

Presynaptic M2-muscarinic receptors on noradrenergic nerve endings and endothelium-derived M3 receptors in cat cerebral arteries

The muscarinic (M) receptors involved in the vasodilation elicited by acetylcholine (ACh) and in the carbachol inhibition in electrically induced [3H]noradrenaline (NA) release in cat cerebral arteries was investigated. For this, atropine, pirenzepine, AF-DX 116, 4-DAMP, non-specific, M1, M2 and M3 receptor antagonists, respectively, were used. ACh elicited concentration-dependent relaxations up to 10(-6) M which were attenuated by these antagonists; the order of potency (pA2 values) to inhibit the ACh-induced relaxation was: atropine (10.1) 4-DAMP (8.9) greater than pirenzepine (7.6) greater than AF-DX 116 (5.9). The electrical stimulation (200 mA, 0.3 ms, 2 Hz, during 1 min) of these arteries preincubated with [3H]NA caused tritium release which was inhibited by carbachol (10(-6) M). The 4 antagonists attenuated the action of the M agonist; the order of potency (pIC50 values) was: atropine (8.7) greater than 4-DAMP (8.1) greater than AF-DX 116 (7.9) greater than pirenzepine (5.8). The action of McN-A-343, a putative M1 agonist, was also investigated. This agent produced small vasodilator responses and elevated concentrations (5 x 10(-5) M) inhibited the stimulated NA release, which was partially antagonized by atropine (10(-7) M) and pirenzepine (10(-8) and 10(-7) M). These results suggest the existence of M3 and M2 receptors mediating the relaxation induced by ACh and the NA release inhibition evoked by carbachol, respectively.

Characterization of the subtype of presynaptic alpha 2-adrenoceptors modulating noradrenaline release in cat and bovine cerebral arteries

The possible existence of a heterogeneous population of alpha 2-adrenoceptors (alpha 2A and alpha 2B, demonstrated by binding studies) in adrenergic nerve endings of cat and bovine cerebral arteries modulating noradrenaline release was investigated. Electrical field stimulation elicited an increase of tritium secretion from these vessels preincubated with (+/-)-[3H]noradrenaline, which was reduced by the alpha 2-agonists, clonidine (1 microM) and B-HT 920 (0.01 and 0.1 microM), in cat cerebral arteries but only by B-HT 920 in bovine cerebral arteries. This reduction was inhibited by the antagonist of the alpha 2B-subtype, prazosin, and the antagonists of alpha 2A- and alpha 2B-subtypes yohimbine and particularly rauwolscine. The effect of B-HT 920 was partially inhibited by clonidine in bovine, but not in cat cerebral arteries. In both types of arteries, prazosin, yohimbine and the alpha 1-agonist methoxamine (all at 1 microM) failed to modify the stimulated radioactivity liberation, whereas it was increased by 1 microM rauwolscine, and by yohimbine plus prazosin in cat cerebral arteries. The basal tritium release was enhanced by rauwolscine and prazosin in cat cerebral arteries but only by the latter in bovine cerebral arteries. These results suggest: (1) the existence of presynaptic alpha 2-adrenoceptors, mainly of the alpha 2B-subtype, in these vessels negatively modulating noradrenaline release, their activity being greater in cat than in bovine cerebral arteries, and (2) clonidine has no agonistic but a weak antagonistic action in the latter vessels.

Effects of phorbol 12,13-dibutyrate on the vascular tone and on norepinephrine- and potassium-induced contractions of cat cerebral arteries

Phorbol 12,13-dibutyrate (PDB), an activator of protein kinase C (PKC), induced slow-developing sustained contractions in segments of cat middle cerebral arteries. PDB-induced responses were not affected by phentolamine (1 microM) and endothelium removal, and were reduced by 1-(5-isoquinoline sulfonyl)-2-methylpiperazine (25 microM) and staurosporine (10 nM), PKC inhibitors. Forskolin (25 microM) produced a rapid and marked vasodilation in segments contracted with PDB. The 4 alpha-phorbol 12,13-didecanoate, an inactive compound, induced slight vasodilation. Preincubation with nifedipine diminished the responses elicited by PDB at all concentrations used. Ca-free medium containing 3 mM ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA), but not 1 mM, markedly reduced the phorbol-induced responses at concentrations up to 10 nM. Nifedipine (0.1 microM) and forskolin (25 microM) produced a rapid and marked relaxation of PDB (10 nM)-evoked contractions in segments incubated in a Ca-free solution (1 mM EGTA), but PBD responses in 3 mM EGTA were not affected by nifedipine. PDB (10 and 100 nM) practically did not modify K-induced contractions, but reduced vasoconstrictions elicited by different norepinephrine concentrations; this effect was phorbol concentration and preincubation time-dependent. These results indicate that: 1) PDB induced PKC activation and contraction mainly produced by Ca entry (essentially at low PDB concentrations) through dihydropyridine-sensitive Ca channels; 2) the activated PKC has elevated sensitivity for Ca; 3) PKC may be involved in the alpha adrenoceptors desensitization, but did not play an important role in the norepinephrine-induced contraction in these arteries.

Therapeutic management of nausea and vomiting

1. The aim of this study is to review the mechanisms implicated in nausea and vomiting and the treatment of these symptoms. 2. Metoclopramide, a benzamide, is the drug most frequently used to alleviate or abolish the majority of nausea and vomiting of different origin. Domperidone, which scarcely penetrates the central nervous system (CNS), is less used. 3. The treatment of vomiting induced by cytotoxic drugs is necessary to use a combination (two or more) of antiemetic drugs (metoclopramide, glucocorticoids, antihistamines, butyrophenones, anticholinergics, cannabinoids). Recently, antagonists of serotonergic (5-HT) receptors of the subtype 5-HT3 appear to possess interesting antiemetic properties and they have a promising future in this field. 4. Antagonists of dopamine receptors (benzamides, phenotiazines, butyrophenones and domperidone) induce adverse reactions in CNS (mainly extrapyramidal disorders), which are scarce with metoclopramide and practically absent with domperidone. These disorders must not suppress antiemetic therapy when it is needed.

Regulation of noradrenaline release in human cerebral arteries via presynaptic alpha 2-adrenoceptors

1. Electrical stimulation induced tritium release from branches of human middle cerebral arteries preincubated with [3H]noradrenaline (NA), which was reduced by the alpha 2-adrenoceptor agonists, clonidine and B-HT 920, and not affected by the alpha 1-agonist, methoxamine. 2. The stimulated tritium release was inhibited by yohimbine (alpha 2-antagonist), and increased by phentolamine (alpha-antagonist) and prazosin (alpha 1-antagonist). 3. The inhibitory effect of clonidine was antagonized by yohimbine. 4. NA uptake was markedly reduced when the interval between the death and the autopsy was greater than 5 hr. 5. These data indicates the existence of presynaptic inhibitory alpha 2-adrenoceptors, but not alpha 1, in human cerebral arteries, and that the adrenergic nerve endings start to degenerate from 5 hr after death.