Multiple sites of oxygen sensing and their contributions to hypoxic pulmonary vasoconstriction

Oxygen sensing by the pulmonary vasculature is important for the regulation of vessel tone and the matching of lung perfusion to ventilation. Airways hypoxia is a major stimulus for vasoconstriction, which diverts blood from hypoxic alveoli to better ventilated areas of the lung. Several hypotheses have emerged to explain how pulmonary arteries sense a decrease in oxygen and mediate hypoxic pulmonary vasoconstriction (HPV). They differ mainly in where they place the main site of HPV: in the endothelial or smooth muscle cells of the artery wall. HPV probably results from synergistic actions on both cell types, but it can proceed in the absence of endothelium, suggesting that the primary oxygen sensor is the smooth muscle cell and endothelium-derived agents modulate the muscle response. Several oxygen-sensing targets have been identified in smooth muscle, including potassium channels, Ca(2+) stores in the sarcoplasmic reticulum (SR) and the Ca(2+) sensitivity of the contractile proteins. The evidence for different oxygen-sensing mechanisms in pulmonary vessels is discussed.     

Endothelium-derived mediators and hypoxic pulmonary vasoconstriction

The vascular endothelium synthesises, metabolises or converts a multitude of vasoactive mediators, and plays a vital role in the regulation of pulmonary vascular resistance. Its role in hypoxic pulmonary vasoconstriction (HPV) is however controversial. Although HPV has been demonstrated in both pulmonary arteries where the endothelium has been removed and isolated pulmonary artery smooth muscle cells, many reports have shown either partial or complete dependence on an intact endothelium for sustained HPV (> approximately 20 min). However, despite many years of study no known endothelium-derived mediator has yet been unequivocally shown to be essential for HPV, although several may either facilitate the response or act as physiological brakes to limit the extent of HPV. In this article we review the evidence for and against the role of specific endothelium-derived mediators in HPV. We make the case for a facilitatory or permissive function of the endothelium, that in conjunction with a rise in smooth muscle intracellular Ca(2+) initiated by a mechanism intrinsic to smooth muscle, allows the development of sustained HPV. In particular, we propose that in response to hypoxia the pulmonary vascular endothelium releases an as yet unidentified agent that causes Ca(2+) sensitisation in the smooth muscle.     

Role of O(2)-sensitive K(+) and Ca(2+) channels in the regulation of the pulmonary circulation: potential role of caveolae and implications for high altitude pulmonary edema

High altitude pulmonary edema (HAPE) is a potentially fatal complication in response to exposure to low O(2) at high altitudes. Hypoxia, by causing pulmonary vasoconstriction, increases pulmonary vascular resistance and pulmonary arterial pressure, both of which are features in the pathogenesis of HAPE. Uneven hypoxic pulmonary vasoconstriction is thought to be responsible for increased capillary pressure and leakage, resulting in edema. O(2)-sensitive ion channels are known to play pivotal roles in determining vascular tone in response to hypoxia. K(+), Ca(2+) and Na(+) channels are ubiquitously expressed in both endothelial and smooth muscle cells of the pulmonary microvasculature, subfamilies of which are regulated by local changes in P(O(2)). Hypoxia reduces activity of voltage-gated K(+) channels and down-regulates their expression leading to membrane depolarization, Ca(2+) influx in pulmonary artery smooth muscle cells (by activating voltage-dependent Ca(2+) channels) and vasoconstriction. Hypoxia up-regulates transient receptor potential channels (TRPC) leading to enhanced Ca(2+) entry through receptor- and store-operated Ca(2+) channels. Altered enrichment of ion channels in membrane microdomains, in particular in caveolae, may play a role in excitation-contraction coupling and perhaps in O(2)-sensing in the pulmonary circulation and thereby may contribute to the development of HAPE. We review the role of ion channels, in particular those outlined above, in response to low O(2) on vascular tone and pulmonary edema. Advances in the understanding of ion channels involved in the physiological response to hypoxia should lead to a greater understanding of the pathogenesis of HAPE and perhaps in the identification of new therapies.     

急性低氧大鼠肺动脉平滑肌内质网钙信号的变化及意义

目的：观察急性低氧大鼠肺动脉平滑肌内质网钙信号的变化及意义。方法:细胞水平：钙荧光探针(Fura-2/AM)负载大鼠肺动脉平滑肌细胞（PASMCs），荧光分光光度法，细胞外液无Ca2+及含Ca2+，在常氧（37 ℃、5% CO2、21 %O2、74 %N2 ）和急性低氧(37 ℃、5% CO2、2% O2、93 %N2)时，检测理阿诺碱（RD）和环匹阿尼酸（CPA）等对细胞浆内游离钙离子浓度（［Ca2+］i）的影响；离体血管环水平：相同条件，离体血管灌流方法检测肺动脉环张力变化。结果:(1)急性低氧时［Ca2+］i升高：常氧组［Ca2+］i为（96.99±7.16） nmol/L，低氧组为(257.06±32.48) nmol/L (P<0.01)。(2)与低氧组比较，预先用RD或普鲁卡因(procain)抑制内质网理阿诺碱受体敏感钙库，随后再给予低氧刺激时［Ca2+］i不升高，为（100.91±11.21） nmol/L (P<0.01)；而用CPA或thapsigargin（TG）抑制内质网摄取Ca2+，再给低氧刺激时［Ca2+］i呈升高状态(P>0.05)，而在细胞外液含钙及低氧下CPA及TG引起［Ca2+］i进一步升高(P<0.05)。(3)低氧引起肺动脉环收缩：常氧对基础张力无影响，低氧引起肺动脉环收缩，最大收缩张力达（49.28±8.64） g/g,P<0.01。(4)与低氧组比较，预先用RD或procain抑制内质网理阿诺碱受体敏感钙库，再给予低氧刺激，肺动脉环不收缩，最大收缩张力（3.75±1.14） g/g, P<0.01；而用CPA或TG后，再给予低氧刺激，肺动脉环呈收缩状态(P>0.05)，而在细胞外液含钙及低氧下CPA及TG引起肺动脉环进一步收缩(P<0.05)。结论:急性低氧可以引起内质网释放Ca2+，至少来自理阿诺碱受体敏感钙库的Ca2+释放参与了低氧肺血管收缩的发病机制；这可能是PASMCs自身具有的，既不依赖细胞外Ca2+内流，也不依赖血管内皮。     

Hypoxic pulmonary vasoconstriction: cyclic adenosine diphosphate-ribose,smooth muscle Ca(2+) stores and the endothelium

Hypoxic pulmonary vasoconstriction (HPV) is unique to pulmonary arteries, and supports ventilation/perfusion matching. However, in diseases such as emphysema, HPV can promote hypoxic pulmonary hypertension (HPH), which ultimately leads to right heart failure. Since it was first described, the mechanisms underpinning HPV have remained obscure, and current therapies for HPH are poor. Previous investigations have suggested that HPV may be mediated by processes intrinsic to the pulmonary artery smooth muscle, and by the release of a vasoconstrictor(s) from the endothelium. It was thought that oxygen-sensitive ion channels in the smooth muscle cell membrane triggered HPV, and it has been argued that the endothelium-derived vasoconstrictor is endothelin-1. However, these proposals remain controversial. This review discusses the regulation by hypoxia of cyclic adenosine diphosphate-ribose production and Ca(2+) release from the sarcoplasmic reticulum in pulmonary artery smooth muscle. The role of these processes in triggering maintained HPV is then related to its subsequent progression due to vasoconstrictor(s) release from the endothelium.     

Carbonic anhydrase inhibitors and hypoxic pulmonary vasoconstriction

Acetazolamide and other related carbonic anhydrase (CA) inhibitors have had a long history of effectiveness in prevention and treatment of acute mountain sickness (AMS) and remain the standard of care for this indication. Despite many decades of CA inhibitor use for AMS, the possibility has never been seriously entertained that these drugs might also afford protection against high altitude pulmonary edema (HAPE). In this paper, I will present our evidence and supporting data of others, that acetazolamide has inhibitory effects on the hypoxic response of the pulmonary circulation that may be useful in HAPE. Data from pulmonary artery smooth muscle cells, isolated perfused lungs, and live unanethetized animals all point to a potent reduction in hypoxic pulmonary vasoconstriction (HPV) by acetazolamide that may have clinical utility in HAPE and possibly other pulmonary hypertensive disorders. Astonishingly, the efficacy of acetazolamide as a HPV inhibitor does not appear to be related to carbonic anhydrase inhibition, since other potent CA inhibitors have no effect on HPV either in the conscious dog or on hypoxic calcium (Ca(2+)) signalling in rat pulmonary artery smooth muscle cells, despite enzyme presence in these cells. Although we have not yet determined the mechanism of action for acetazolamide in HPV, we have ruled out actions on membrane L-type Ca(2+) channels, normoxic and hypoxic membrane potential and rho-kinase activation. Based upon these negative findings in isolated pulmonary artery smooth muscle cells and preliminary data in Ca(2+) free media we propose that acetazolamide may act at the level of Ca(2+) release from the sarcoplasmic reticulum, a process which initiates and amplifies cell membrane Ca(2+) channel opening. In further work, we have developed and will use a methylated analog of acetazolamide to yield a molecule lacking CA inhibiting activity, but which in most other respects (size, pK(a), heterocyclic ring structure, electrostatic charge distribution) is equivalent to acetazolamide.     

Ca2+ and Mg-ATP activated potassium channels from rat pulmonary artery.

We have observed a novel class of calcium-activated potassium channel which is activated by physiological levels of intracellular ATP. These KCa,ATP channels are found on smooth muscle cells isolated from the pulmonary artery. Since their activation by ATP is Mg2+ dependent and is poorly evoked by non- or slowly-hydrolyzed ATP analogues, we conclude that it involves phosphorylation. We suggest that in hypoxia a reduction of intracellular ATP may reduce KCa,ATP channel activity and thereby tend to depolarize the cells. This effect would increase Ca2+ entry through voltage-activated Ca2+ channels and contribute to vasoconstriction.     

低氧诱导肺血管平滑肌细胞诱生型一氧化氮合酶基因表达

本研究采用原位杂交、免疫组织化学、酶组织化学染色方法从三个层次分别证明低氧诱导大鼠肺血管中膜平滑肌细胞一氧化氮合酶（ＮｉｔｒｉｃＯｘｉｄｅＳｙｎｔｈａｓｅ，ＮＯＳ）的基因和蛋白表达，并使中膜平滑肌细胞具有ＮＯＳ活性；离体培养的肺动脉平滑肌细胞实验也证明低氧使肺动脉平滑肌细胞ＮＯＳ活性增加，ＮＯ生成增多。提示诱生型ＮＯＳ基因可能是一种低氧诱导基因，低氧诱导ＮＯＳ表达可能是细胞感受低氧的一种重要机制。     

Ca2+ and ion channels in hypoxia-mediated pulmonary hypertension

Alveolar hypoxia, a consequence of many lung diseases, can have adverse effects on the pulmonary vasculature. The changes that occur in the pulmonary circulation with exposure to chronic hypoxia include reductions in the diameter of the pulmonary arteries due to structural remodeling of the vasculature. Although the structural and functional changes that occur in the development of pulmonary hypertension have been well investigated, less is known about the cellular and molecular mechanisms of this process. This review will discuss the role of several potassium and calcium channels in hypoxic pulmonary vasoconstriction, both in elevating calcium influx into pulmonary artery smooth muscle cells (PASMCs). In addition to other signal transduction pathways, Ca²⁺ signaling in PASMCs plays an important role in the development and progression of pulmonary hypertension due to its central roles in vasoconstriction and vascular remodeling. This review will focus on the effect of chronic hypoxia on ion channels and the potential pathogenic role of Ca²⁺ signaling and regulation in the progression of pulmonary hypertension.     

缺氧对平滑肌膜电位的影响

新鲜分离的猪肺叶内动脉，予以１００％氧气平衡，记录并连续观察其平滑肌膜电位。实验发现，通１００％氮气以降低氧张力时，可引起膜电位快速的超极化反应及其后持续的去极化。去除内皮或细胞外钙离子可致超极化反应完全消失，并使去极化程度降低。提示缺氧引起的超极化反应依赖于内皮和细胞外钙。由此推测缺氧通过外钙内流刺激肺动脉内皮细胞释放内皮源性超极化因子，参与调节急性缺氧性肺血管收缩反应。本实验还记录到平滑肌细胞静息膜电位自发性振荡，缺氧可使其振幅降低，振荡频率稍慢     

Clinical perspective of hypoxia-mediated pulmonary hypertension

Pulmonary hypertension is a condition associated with a variety of pulmonary disorders whose common denominator is alveolar hypoxia. Such disorders include chronic obstructive pulmonary disease, pulmonary fibrosis, sleep-disordered breathing, and exposure to high altitude. Acute hypoxia is characterized by vasoconstriction of small pulmonary arteries, a phenomenon called hypoxic pulmonary vasoconstriction. With prolonged hypoxia, thickening of the smooth vascular layer of the small pulmonary arteries occurs, a phenomenon described as pulmonary vascular remodeling. Although the core mechanisms of both vasoconstriction and remodeling are thought to reside in the smooth muscle cell layer, the endothelium modulates these two processes. The purpose of this review is briefly to (a) discuss the mechanisms of hypoxic pulmonary hypertension as it pertains to certain disease states, and (b) examine the pathways that have potential therapeutic applications for this condition.     

External K+ increases Na+ conductance of the hyperpolarization-activated current in rabbit cardiac pacemaker cells

We have observed a novel class of calcium-activated potassium channel which is activated by physiological levels of intracellular ATP. These K_Ca,ATP channels are found on smooth muscle cells isolated from the pulmonary artery. Since their activation by ATP is Mg²⁺ dependent and is poorly evoked by nonor slowly-hydrolyzed ATP analogues, we conclude that it involves phosphorylation. We suggest that in hypoxia a reduction of intracellular ATP may reduce K_Ca,ATP channel activity and thereby tend to depolarize the cells. This effect would increase Ca²⁺ entry through voltage-activated Ca²⁺ channels and contribute to vasoconstriction.     

COPD合并慢性缺氧患者肺血管对急性缺氧反应变化中肺动脉平滑肌细胞钾通道的作用

目的：以人离体肺动脉环缺氧张力变化为对象研究钾通道在缺氧性肺血管收缩（HPV）发生中的作用。 方法： 从手术室切取人肺动脉环，进行人肺动脉环张力试验，分正常对照组，单纯慢性阻塞性肺病（chronic obstructive pulmonary disease ，COPD）组和COPD合并慢性缺氧组，分别利用相应的特异性阻断剂观察电压门控性钾通道（KV），钙离子激活的钾通道（KCa）， ATP敏感的钾通道（KATP），在缺氧性肺血管收缩（HPV）的作用。 结果： （1）3组肺动脉环在急性缺氧时血管收缩张力均增加，同时COPD＋慢性缺氧组增加百分比显著低于对照组；COPD组与对照组无显著差异。（2）4-AP阻断Kv后较阻断前，3组肺血管环缺氧张力增加幅度均显著降低（P<0.05），同时正常对照组和COPD组降低幅度明显大于慢性缺氧组。TEA阻断KCa后以及格列苯脲（glybenclamide）阻断KATP后二者较阻断前，3组肺血管环缺氧张力均显著增加（P<0.05），同时COPD＋慢性缺氧组增加的幅度明显大于正常组（分别是P<0.01和P<0.05）。 结论： （1）慢性缺氧可降低肺血管的收缩性及肺血管对急性缺氧的收缩反应；（2）Kv在3组人离体肺动脉环HPV反应中均起介导作用，慢性缺氧可使此介导作用加强；KCa和KATP在3组人离体肺动脉环HPV反应中均起调节作用，慢性缺氧可使此调节作用加强。     

Inhibition effect of arachidonic acid on hypoxia-induced [Ca(2+)](i) elevation in PC12 cells and human pulmonary artery smooth muscle cells

[Ca(2+)](i) elevation is a key event when O(2) sensitive cells, e.g. PC12 cells and pulmonary artery smooth muscle cells, face hypoxia. Ca(2+) entry pathways in mediating hypoxia-induced [Ca(2+)](i) elevation include: voltage-gated Ca(2+) channels (VGCCs), transient receptor potential (TRP) channel and Na(+)-Ca(2+) ex-changer (NCX). In the pulmonary artery, accumulated evidence strongly suggests that prostaglandins (PGs) are involved in pulmonary inflammation and cause vasoconstriction during hypoxia. In this study, we investigated the effect of arachidonic acid (AA), the upstream substrate for PGs, on hypoxia response in O(2) sensitive cells. Exogenous application of AA significantly inhibited hypoxia-induced [Ca(2+)](i) elevation. This effect was due to AA itself rather than its degenerative products. The pharmacological modulation of endogenous AA showed that the prevention of AA generation by blockage of cPLA2, diacylglycerol (DAG) lipase and fatty acid hydrolysis (FAAH), augments hypoxia-induced [Ca(2+)](i) elevation, whereas prevention of AA degeneration attenuates hypoxia-induced [Ca(2+)](i) elevation. Over-expression of COX2 enhances hypoxia-induced [Ca(2+)](i) elevation and this enhancement is reversed by exogenous AA. Our results suggest that AA inhibits hypoxia response. The dynamic alterations in cellular lipids might determine cell response to hypoxia.     

Acute and chronic hypoxic pulmonary vasoconstriction: a central role for endothelin-1?

In the pulmonary circulation, a decrease in oxygen tension results in the development of hypoxic pulmonary vasoconstriction (HPV), although the exact mechanism by which HPV occurs remains unclear. Evidence gathered from many laboratories suggests that while pulmonary arterial smooth muscle cells (PASMCs) can sense and respond to changes in oxygen tension, full expression of HPV requires modulating influences from the endothelium. In this review, we propose a model of HPV, based on recent studies from our laboratory, in which endothelin-1 (ET-1), a vasoactive peptide released from the endothelium, plays a central role and discuss how this model may be involved in the long-term adaptation to hypoxia.     

Role of O2-sensitive K and Ca channels in the regulation of the pulmonary circulation: Potential role of caveolae and implications for high altitude pulmonary edema

High altitude pulmonary edema (HAPE) is a potentially fatal complication in response to exposure to low O₂ at high altitudes. Hypoxia, by causing pulmonary vasoconstriction, increases pulmonary vascular resistance and pulmonary arterial pressure, both of which are features in the pathogenesis of HAPE. Uneven hypoxic pulmonary vasoconstriction is thought to be responsible for increased capillary pressure and leakage, resulting in edema. O₂-sensitive ion channels are known to play pivotal roles in determining vascular tone in response to hypoxia. K⁺, Ca²⁺ and Na⁺ channels are ubiquitously expressed in both endothelial and smooth muscle cells of the pulmonary microvasculature, subfamilies of which are regulated by local changes in P_O2. Hypoxia reduces activity of voltage-gated K⁺ channels and down-regulates their expression leading to membrane depolarization, Ca²⁺ influx in pulmonary artery smooth muscle cells (by activating voltage-dependent Ca²⁺ channels) and vasoconstriction. Hypoxia up-regulates transient receptor potential channels (TRPC) leading to enhanced Ca²⁺ entry through receptor- and store-operated Ca²⁺ channels. Altered enrichment of ion channels in membrane microdomains, in particular in caveolae, may play a role in excitation–contraction coupling and perhaps in O₂-sensing in the pulmonary circulation and thereby may contribute to the development of HAPE. We review the role of ion channels, in particular those outlined above, in response to low O₂ on vascular tone and pulmonary edema. Advances in the understanding of ion channels involved in the physiological response to hypoxia should lead to a greater understanding of the pathogenesis of HAPE and perhaps in the identification of new therapies.     

Iptakalim, a novel ATP-sensitive potassium channel opener, inhibits pulmonary arterial smooth muscle cell proliferation by downregulation of PKC-α

Iptakalim is a new ATP-sensitive potassium (K ATP ) channel opener, and it inhibits the proliferation of pulmonary arterial smooth muscle cells (PASMCs) and pulmonary vascular remodeling. However, the underlying mechanism remains unclear. In the present study, we found that iptakalim significantly decreased pulmonary artery pressure, inhibited pulmonary ariery remodeling and PKC-α overexpression in chronic hypoxia in a rat pulmonary hypertension model. Iptakalim reduced hypoxia-induced expression of PKC-α, and abolished the effect of hypoxia on PASMC proliferation significantly in a dose-dependent manner in vitro. Moreover, these effects were abolished by glibenclamide, a selective K ATP channel antagonist. These results indicate that iptakalim inhibits PASMC proliferation and pulmonary vascular remodeling induced by hypoxia through downregulating the expression of PKC-α. Iptakalim can serve as a novel promising treatment for hypoxic pulmonary hypertension.     

K~ 通道在正常与慢性低氧大鼠低氧性肺血管收缩反应中的作用

目的 :探讨K 通道在慢性低氧致低氧性肺血管收缩反应降低中的作用。方法 :采用离体肺灌流实验 ,研究 4-AP(4-aminopyridine ,电压依赖性K 通道 -Kv阻滞剂 )、TEA(tetraethylamonium ,Ca2 激活性K 通道 -KCa阻滞剂 )、GLIB(glibenclamide,ATP敏感性K 通道 -KATP阻滞剂 )对正常与慢性低氧大鼠肺血管低氧反应的影响。结果 :4-AP、TEA均可使正常大鼠肺动脉基础压上升 ,且使其肺血管低氧反应明显增强 ;对于慢性低氧大鼠 ,其肺血管对低氧反应明显低下 ,4-AP、TEA升肺动脉基础压的作用明显低于对照鼠肺 ,GLIB也呈现升高肺动脉基础压力作用 ,4-AP、TEA、GLIB均可使肺血管低氧反应大大增强 ,增强的比例明显大于正常对照组。结论 :在离体灌流鼠肺HPV中 ,Kv、KCa的开放起调节作用 ,大鼠经慢性低氧后 ,肺血管反应性明显降低 ,可能与Kv、KCa、KATP在HPV中的调节作用相对增强有关     

Vasoreactions to acute hypoxia,whole lungs and isolated vessels compared: modulation by NO

We aimed to explain diverse pulmonary vascular responses to hypoxia in different preparations and their modulation by NO. In rats we compared isolated perfused lungs (IPL), small vessels in vitro (PRVs) and in vivo preparations. In IPL and in vivo, acute and chronic nitric oxide synthase (NOS) blockade with L-NAME left normoxic pulmonary artery pressure unchanged but enhanced hypoxic vasoconstriction, hypoxia-induced pulmonary vasoconstriction (HPV). PRVs in vitro, precontracted with PGF(2alpha), showed four tension changes in acute hypoxia: dilatation, contraction, dilatation, contraction. Acute and chronic NOS blockade reduced the first two phases. In non-precontracted PRVs (from other laboratories), NOS inhibition enhanced HPV as in vivo and IPL; attenuation of HPV seems associated with precontraction. Thus reduced NOS activity does not cause pulmonary hypertension but exaggerates HPV. In IPL, prolonged severe hypoxia caused biphasic vasoconstriction separated by dilatation; the time course resembled that seen in PRVs. We suggest that the sequence of events during hypoxia in PRVs can be detected in whole lung preparations.     

埃他卡林对原代培养人肺动脉平滑肌细胞转化生长因子β1mRNA表达的影响

目的研究新型ATP敏感性钾（KATP）开放剂埃他卡林（IPT）对缺氧诱导原代培养人肺动脉平滑肌细胞转化生长因子β1（TGF—β1）mRNA表达的影响。方法分离3～4级人肺小动脉,按照组织贴块法原代培养人肺动脉平滑肌细胞,应用实时荧光定量逆转录聚合酶链反应（RQ-RT—PCR）技术检测细胞TGF—B,mRNA表达情况。结果缺氧使原代培养人肺动脉平滑肌细胞TGF—β1 mRNA表达增加;相同条件下,在缺氧的同时,分别在培养基中加入IPT 10^-7、10^-6、10^-5 mol·L^-1,IPT呈浓度依赖性地抑制细胞TGF—β1 mRNA表达;加入IPT 10^-5 mol·L^-1前30min,预先加入格列本脲（GLI）10^-7、10^-6、10^-5 mol·L^-1,GLI呈浓度依赖性地拮抗IPT的作用。结论IPT通过激活细胞KATP通道,浓度依赖性地抑制缺氧诱导的原代培养人肺动脉平滑肌细胞TGF-β1 mRNA表达增加。