Endothelium-derived vasoactive factors and regulation of vascular tone in human blood vessels

The endothelium releases a variety of factors which can affect vascular tone. Endothelium-derived relaxing factor or nitric oxide is a very potent vasodilator and inhibitor of platelet function. Its release has been demonstrated in a variety of human blood vessels. In most human vascular preparations, prostacyclin does not significantly contribute to the endothelium-dependènt relaxations. Prostacyclin is, however, an endothelium-derived product which can evoke vasodilation and inhibition of platelet aggregation. In addition, the endothelium of human veins can release endothelium-derived contracting factors produced by the cyclooxygenase pathway. Endothelin is an endothelium-derived vasoactive peptide which has profound vasoconstrictor properties in human arteries and particularly in veins. Its action can only be partially inhibited by calcium antagonists, while endothelium-derived nitric oxide and exogenous nitrovasodilators are effective antagonists of the peptide. The mechanisms and amounts of endothelin released in human blood vessels remains to be defined. Under physiological conditions, endothelium-derived relaxing factors appear to dominate. The release of endothelium-derived nitric oxide is reduced in atherosclerotic human arteries. This indicates that in cardiovascular disease endothelial dysfunction occurs; this may contribute in the pathogenesis of coronary artery disease, pulmonary hypertension and stroke.     

Maturational changes in ovine pulmonary vascular responses to inhaled nitric oxide

Developmental changes in modulation of pulmonary vasomotor tone by endothelium-derived nitric oxide (EDNO) may reflect maturational differences in endothelial synthesis of and/or vascular smooth muscle response to nitric oxide. This study sought to determine whether pulmonary vascular sensitivity and responsiveness to nitric oxide change during newborn development, and whether this is related to changes in guanylate cyclase activity. Pulmonary artery dose-responses to inhaled nitric oxide (iNO, 0.25-100 parts per million) were measured in hypoxic, indomethacin-treated, isolated lungs from 1-day (1-d)- and 1-month (1-m)-old lambs. The lungs of 1-m-old lambs were ventilated with 4% (oxygen) O2, and lungs of 1-d-old lambs were ventilated with either 4% or 7% O2 in order to achieve similar stimuli or vasomotor tone. Cyclic guanosine monophosphate (cGMP) concentrations in the perfusate were measured at iNO concentrations of 0, 5, and 100 parts per million (ppm). Basal and stimulated pulmonary guanylate cyclase activity was also measured in lung extracts in vitro. The effects of iNO were similar in both 1-d groups, even though baseline hypoxic tone was significantly higher in 1-d lungs ventilated with 4% O2 than with 7% O2. Furthermore, both the 1-d 7% O2 and 1-d 4% O2 lungs exhibited greater responsiveness and sensitivity to iNO than 1-m lungs. Perfusate cGMP concentrations and soluble guanylate cyclase activity were higher under stimulated than basal conditions, but neither differed statistically between 1 d and 1 m. These data suggest that pulmonary vascular responsiveness and sensitivity to nitric oxide decrease with age, but the mechanisms underlying these maturational changes require further investigation.     

Vascular stress response and endothelial vasoactive factors for vascular remodelling

In response to several vascular stresses caused by hyperglycaemia, hypertension or hyperlipidemia, endothelial cells (EC) sense these stresses as oxidative stress to secrete several autocrine/paracrine factors, including growth factors/cytokines and vasoactive peptides to regulate vascular tone and remodelling. Vascular stresses induce co-ordinate gene regulation of endothelial vasoactive substances and their related enzymes to cause vasorelaxation and vascular growth inhibition. We speculate that prolonged and excessive vascular stresses impair endothelial function, which results in the imbalance of endothelial production of vasoactive substances and leads to the formation of proliferative vascular lesions.     

Endothelial modulation of pulmonary vascular tone.

Pulmonary endothelial cells normally synthesize prostacyclin (PGI2) and nitric oxide (NO), which are both potent vasodilators. Although PGI2 is largely used to treat patients with severe pulmonary hypertension, its role in the physiology and pathophysiology of the pulmonary circulation is still debated. NO, which is now considered as the endogenous nitrovasodilator, is perhaps more involved than PGI2 in the mechanisms that modulate pulmonary vascular tone in health and disease. There is evidence to suggest that background release of NO contributes to the normally low pulmonary vascular tone in normoxia. Although there are theoretical grounds to hypothesize that hypoxia reduces the synthesis of NO, lack of the latter does not seem to account for the acute hypoxic pulmonary vasoconstriction. Instead, there is evidence to suggest that NO activity is increased in order to modulate the pulmonary vasopressor response to acute alveolar hypoxia. However, more consistent, concerning the role of NO, are data gathered from studies performed in chronic hypoxic conditions. Both experimental data and studies performed in man demonstrate impairment of NO synthesis and/or release in chronic hypoxic pulmonary hypertension. The impaired NO production, whilst reducing the ability of the pulmonary vasculature to relax, also favours the occurrence of excessive pulmonary vasoconstriction. Lack of NO synthesis might also permit mitogenesis and proliferation of various cell types within the vascular wall. We hypothesize that functional alterations of pulmonary endothelium are likely to affect both reactivity and growth of pulmonary vessels. In this respect, NO probably has a pivotal role in modulating pulmonary vascular tone and controlling pulmonary vascular remodelling in health and disease.     

Alteration of endothelial function in arterioles of renal hypertensive rats at two levels of vascular tone.

DESIGN: Arterioles were studied in vivo to determine whether the altered response to endothelium-dependent and -independent vasodilators in one-kidney, one clip (1K1C) hypertensive rats was related to increased vascular tone or precontraction with norepinephrine. METHODS: Acetylcholine, bradykinin and nitroprusside were applied topically to arterioles in the spinotrapezius muscle of 4-week 1K1C hypertensive rats and normotensive control rats. The changes in internal diameter of arcade arterioles in response to four doses of each drug were measured with intravital microscopy before and during superfusion of indomethacin. Arteriolar responses were redetermined during enhancement of vascular tone by superfusion of norepinephrine. RESULTS: Vasodilation in response to acetylcholine, but not to nitroprusside, was reduced in 1K1C rats compared with normotensive rats. Indomethacin decreased the resting arteriolar diameter, but did not alter the response to acetylcholine or nitroprusside. The response to bradykinin, which was partly attenuated after cyclo-oxygenase inhibition, was also reduced in 1K1C rats. The attenuated endothelium-dependent responses in 1K1C rats may have been a result of changes in the synthesis or release of endothelium-derived relaxing factor because the response to the endothelium-independent vasodilator nitroprusside was unchanged. Indomethacin attenuated the vasodilation of bradykinin, which suggests that prostacyclin is involved in this action in vivo. CONCLUSIONS: Precontraction with norepinephrine did not change any of the responses, indicating that the reduced endothelial-dependent responses in hypertensive rats cannot be explained by differences in vascular tone.     

急性肺动脉栓塞血流动力学和血管活性物质的动态变化

目的 探讨急性弥漫性肺动脉栓塞血流动力学和血管活性物质动态变化。方法 健康家猪16只,随机分为实验组8只,对照组8只。经颈外静脉插管快速注入多聚乙烯微球栓子（0.1g/kg）制作猪急性肺动脉栓塞模型为实验组,而对照组仅注射0.9%生理盐水50ml。观察实验过程中血流动力学、内皮素-1（ET-1）和血栓素A2（TXA2）的代谢产物TXB2的动态变化。结果 多聚乙烯微球栓子可诱发急性肺动脉压升高,持续约1～2h。ET-1和TXA2分别于栓塞后0.5h和2h检测到浓度升高,在整个实验过程中持续在较高水平。结论 急性肺动脉栓塞时血流动力学动态变化和急性肺损伤是肺小动脉机械性栓塞和血管活性物质ET-1和TXA2共同作用的结果。     

Altered endothelial modulation of vascular tone in aging and hypertension

The role of endothelial cells in modulating the vascular smooth muscle tone in aging and hypertension was examined. Results from in vitro pharmacological studies indicate that vasodilations of rat arteries induced by several dilator agents, such as nitrovasodilators, decrease with advancing age and experimental hypertension. These diminished dilator responses to nitrovasodilators however were not observed in arteries with endothelial cells removed. Furthermore, 8-bromo-cGMP-induced relaxations were not different between arteries with and without endothelial cells and were not affected by hypertension. It appears that the diminished vasodilator responses in aging and hypertension is not initially due to defects in vascular smooth muscle but rather due to an altered modulatory function of the endothelial cells. At different ages and under different pathological conditions, such as hypertension, the ratio of production and/or activities of endothelium-derived relaxing factors and endothelium-derived constrictor factors may vary, and therefore directly or indirectly affect the production of cGMP and smooth muscle tone.     

Role of tyrosine phosphatase in the modulation of pulmonary vascular tone.

In the vascular system, synthesis of the potent vasodilator nitric oxide (NO) is tightly regulated by the constitutively expressed endothelial NO synthase (eNOS). Activity of eNOS is controlled by Ca2+/calmodulin and various seryl/threonyl protein kinases. Less is known about the importance of phosphorylation and dephosphorylation of tyrosyl residues. Therefore the role of tyrosine phosphatase on the modulation of isolated rat pulmonary artery tone has been assessed. Inhibition of tyrosine phosphatase by sodium orthovanadate (SOV, 1x10(-6) M) significantly: 1) increased phenylephrine-induced vasoconstriction and 2) decreased endothelium-dependent relaxation to acetylcholine, but had no effect on endothelium-independent relaxation to the NO donor, sodium nitroprusside. In phenylephrine-precontracted pulmonary arterial rings, SOV (1x10(-7)-1x10(-5) M) had no effect on vascular tone but significantly relaxed rings which were pretreated with the NO-synthase inhibitor, N(omega)-nitro-L-arginine-methyl ester (L-NAME). SOV-induced relaxation in the presence of L-NAME was, however, abolished by glibenclamide. In conclusion, inhibition of tyrosine phosphatase altered pulmonary vascular tone by increasing vasoconstrictor response to phenylephrine and decreasing endothelium-dependent relaxation to acetylcholine. Furthermore, the tyrosine phosphatase inhibitor, sodium orthovanadate, exhibited original vasodilator properties which were only observed when nitric oxide synthesis was inhibited. Thus a new pathway involving the inhibitory effect of nitric oxide on a glibenclamide-sensitive diffusible relaxing factor, that might play an important role in the control of pulmonary vascular tone is described.     

Effect of preterm birth on hypoxia-inducible factors and vascular endothelial growth factor in primate lungs

Diminished vascular and alveolar development is characteristic of bronchopulmonary dysplasia (BPD). The low fetal O(2) tension promotes angiogenic responses during ontogenesis, while preterm birth interrupts normal lung growth. Most of the angiogenic responses are governed by hypoxia-inducible factors (HIFs), the expressions of which are unknown in the lungs of preterm primates. Lung tissue was harvested from fetal third-trimester baboons as well as from preterm baboons (67% or 75% of term gestation) treated with mechanical ventilation and either pro re nata (PRN) or 100% O(2). Both groups of preterm animals developed lung hypoplasia similar to human BPD. Expression of HIF-1alpha protein by Western blotting of nuclear extracts of fetal baboon samples differed from that of HIF-2alpha in that both were high at early third trimester, but at term, HIF-1alpha was absent, whereas HIF-2alpha remained unchanged. Moreover, the expression of prolyl hydroxylase domain-containing proteins 2 and 3 (PHD-2 and -3), which degrade HIFs, was increased following term birth. HIF-1alpha was diminished both in 125-day and 140-day BPD models, whereas HIF-2alpha was reduced only in the latter. Surprisingly, vascular endothelial growth factor (VEGF) was enhanced in preterm baboons with BPD as compared with age-matched fetal controls, and there was a negative correlation between HIF-1alpha and/or HIF-2alpha and VEGF in BPD. Moreover, VEGF receptors KDR and/or Flt-1 were decreased in BPD. Preterm birth also prevented the end-gestational increase in the expression of endothelial cell marker platelet-endothelial cell adhesion molecule 1. These results suggest that selective downregulation of HIFs in lungs of preterm neonates may contribute to the pathophysiology of BPD.     

Redox status in the control of pulmonary vascular tone

There is mounting evidence that the tone, and possibly the structure, of the pulmonary vasculature is regulated by the redox status (GSH/GSSG, NADPH/NADP) of the pulmonary vascular smooth muscle cell. This hypothesis may explain some studies which have examined endogenous mediators and inhibitors of oxidative phosphorylation. An analogous model of redox regulation of cellular function and calcium flux is seen in the pancreatic beta-cell. The importance of redox status in the regulation of enzyme reactivity is well recognized. Sulfhydryl redox status may also be involved in the ability of the carotid body to detect changes in oxygen tension. It is likely that sulfhydryl redox status transduces the effect of changing oxygen tension for many physiologic control systems, including the pulmonary vasculature.     

The acute effects of dexfenfluramine on human and porcine pulmonary vascular tone and resistance.

STUDY OBJECTIVES: Treatment with anorectics has become an important aspect of care for the severely obese. One such anorectic, the phenylethylamine dexfenfluramine (dFen), has been associated with the development of pulmonary hypertension. It works by reducing the neuronal uptake of 5-hydroxytryptamine (5-HT; serotonin) through inhibition of the 5-HT transporter. In this study we investigated whether dFen has a direct vasoconstrictor action on human and porcine pulmonary vasculature. DESIGN: For the human study, tissue was obtained from patients who had undergone lung and heart-lung transplantation. The effect of dFen was studied in seven isolated colloid perfused human lungs and in rings of human pulmonary artery (PA) dissected from the lungs of a further 19 patients. For the porcine study, regional pulmonary vascular resistances (PVRs) were measured in isolated perfused porcine lungs. Vasoconstriction was assessed following dFen alone and in combination with hypoxia, cyclo-oxygenase blockade (indomethacin, 10(-5) mol/L), or nitric oxide synthase (NOS) blockade (N(G)-nitro-L-arginine, 10(-5) mol/L). RESULTS: In the human study, 5-HT and dFen caused only limited increases in tension of isolated rings of PA. The concentration of dFen, 10(-4) mol/L, that was needed to increase tension was higher than that found normally in treated patients where peak levels are 3. 3 x 10(-7) mol/L. Other vasoconstrictors such as prostaglandin F(2)alpha, 10(-5) mol/L, and the thromboxane analog U46619, 10(-6) mol/L, produced far greater increases in tension. Ketanserin, 10(-4) mol/L, attenuated the constrictor response to 5-HT but had no effect on the constrictor response to dFen. Removal of the endothelium did not influence the response to dFen. In the isolated ventilated and perfused lungs, dFen caused an increase in PVR again only at a comparatively high concentration, 10(-4) mol/L. In the porcine study, dFen, 10(-4) mol/L, did not increase any PVR during normoxia or following NOS blockade. Small insignificant increases in PVR occurred during hypoxia and after cyclo-oxygenase blockade. CONCLUSION: These results do not support the view that dFen would act as a direct vasoconstrictor when given in the usual doses. However, delayed elimination of dFen could raise tissue concentrations to high levels and give rise to vasoconstriction and pulmonary hypertension.     

血管内皮生长因子及其受体在肺气肿患者肺组织中的表达

目的探讨血管内皮生长因子(VEGF)及其受体2(VEGF受体2/KDR)在肺气肿患者肺组织中的表达及其与肺气肿的相关性。方法取35例行肺叶切除术患者[A组(吸烟伴肺气肿组)16例,B组(不吸烟肺功能正常组)14例,C组(吸烟但肺功能正常组)5例]的外周肺组织标本,ELISA法检测肺组织匀浆中VEGF的含量,免疫组化法检测KDR蛋白表达,RT PCR检测VEGF和KDRmRNA水平,TUNEL法检测肺泡隔细胞的凋亡。结果A组患者肺组织VEGF、KDR表达均低于B组(P<0.01),肺泡隔细胞凋亡率高于B组(P<0.01)。C组与B组相比,VEGF及KDR表达差异无统计学意义(P>0.05)。结论VEGF及KDR水平减少与肺泡隔细胞凋亡的增加可能与肺气肿的发生相关。     

Normal and pathophysiologic considerations of endothelial regulation of vascular tone and their relevance to nitrate therapy.

During the past decade, it has become clear that the vascular endothelium critically influences vascular permeability, controls vessel growth, modulates hemostasis, and regulates vasomotion. This latter role of the endothelium is mediated by the liberation of a number of potent vasoactive compounds, including endothelium-derived relaxing factors, one of which is either nitric oxide or a compound that releases nitric oxide, vasoactive prostaglandins, hyperpolarizing factors, and a number of constricting factors. This role of the endothelium is dramatically altered by several diseases, including atherosclerosis, hypertension, and diabetes. Abnormalities of endothelial regulation of vascular tone may contribute to a number of clinical syndromes, including variant angina, unstable angina, syndrome X, and perhaps many others. In this review, several aspects of the endothelium-derived relaxing factor will be considered, including recent concepts regarding its synthesis, its chemical identity, and alterations in atherosclerosis. Finally, its action in the coronary microcirculation as contrasted to that of nitroglycerin will be considered.     

高原低氧性肺动脉高压与肺血管内皮功能的相关性研究

目的探讨高原低氧性肺动脉高压(HPH)与肺血管内皮功能的关系。方法选择由平原进驻高原的健康男性官兵80例,年龄18~25岁。进入高原前和进入高原后2 d、30 d、60 d、90 d,分别测定平均肺动脉压(m PAP)、血清低氧诱导促有丝分裂因子(HIMF)、低氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)、血浆内皮素-1(ET-1)和一氧化氮(NO)含量。结果入高原后2 d,m PAP、血清HIMF、HIF-1α、VEGF、血浆ET-1水平明显高于入高原前,NO含量水平明显低于入高原前,(均P0.01);但入高原后2 d的m PAP、血清HIMF、HIF-1α、VEGF、血浆ET-1水平明显低于入高原后30 d,60 d和90 d,NO水平则明显高于入高原后30、60、90 d(均P0.01);入高原后各指标30 d与60 d和60 d与90 d比较无统计学意义(均P0.05)。入高原后2 d,m PAP与HIMF、HIF-1α、VEGF、ET-1呈显著正相关(r=0.568、0.664、0.616、0.598),与NO呈显著负相关(r=-0.608),(均P0.01)。结论 HIMF、HIF-1α、VEGF、ET-1和NO可能共同参与了HPH的发生发展,高原HPH的发生与肺血管内皮功能受损有密切关系。     

肺血管内皮细胞功能障碍与肺动脉高压

肺动脉高压的发病机制是一个复杂的、多因素参与的过程.近年来,逐步形成内皮功能紊乱学说,认为肺血管内皮是引起血管收缩和特征性病理改变的首要因素.本文就肺血管内皮细胞功能障碍和肺动脉高压的研究进展作一综述.     

Nitric-oxide-mediated zinc release contributes to hypoxic regulation of pulmonary vascular tone

The metal binding protein metallothionein (MT) is a target for nitric oxide (NO), causing release of bound zinc that affects myogenic reflex in systemic resistance vessels. Here, we investigate a role for NO-induced zinc release in pulmonary vasoregulation. We show that acute hypoxia causes reversible constriction of intraacinar arteries (<50 microm/L) in isolated perfused mouse lung (IPL). We further demonstrate that isolated pulmonary (but not aortic) endothelial cells constrict in hypoxia. Hypoxia also causes NO-dependent increases in labile zinc in mouse lung endothelial cells and endothelium of IPL. The latter observation is dependent on MT because it is not apparent in IPL of MT(-/-) mice. Data from NO-sensitive fluorescence resonance energy transfer-based reporters support hypoxia-induced NO production in pulmonary endothelium. Furthermore, hypoxic constriction is blunted in IPL of MT(-/-) mice and in wild-type mice, or rats, treated with the zinc chelator N,N,N',N'-tetrakis(2-pyridylmethyl)-ethylenediamine (TPEN), suggesting a role for chelatable zinc in modulating HPV. Finally, the NO donor DETAnonoate causes further vasoconstriction in hypoxic IPL in which NO vasodilatory pathways are inhibited. Collectively, these data suggest that zinc thiolate signaling is a component of the effects of acute hypoxia-mediated NO biosynthesis and that this pathway may contribute to constriction in the pulmonary vasculature.     

Maturational changes in excitation-contraction coupling in mammalian myocardium.

The single sucrose gap voltage clamp technique has been used to study the relation between membrane electrical activity and tension generation in right ventricular papillary muscles from New Zealand White rabbits at various stages of development. In response to voltage clamp-controlled depolarization, muscles from newborn rabbits develop monotonically increasing tension that reaches a steady state level, whereas more mature myocardium responds to similar depolarization by developing an early peak of tension before relaxing to a steady state level. The ratio of early peak or phasic tension to steady state or tonic tension increases significantly with maturation. Calcium (Ca2+) loading of immature myocytes enhances phasic tension in a subsequent test depolarization. Although the voltage dependence of tonic tension increases monotonically in all age groups, phasic tension, seen only in the more mature myocardium, displays a "bell-shaped" dependence on voltage. Addition of ryanodine, known to interfere with Ca2+ release from the sarcoplasmic reticulum, markedly reduces the phasic component of tension in mature myocardium, and the voltage clamp-induced tension in the adult closely resembles that of the normal newborn. These results suggest that tension development in immature myocardium is supported largely by the influx of Ca2+ across the sarcolemma. As the myocardium matures, the sarcoplasmic reticulum plays an increasingly important role in tension generation. A developmental schema is presented to account for the observed maturational changes in excitation-contraction coupling. The clinical implications of these changes are discussed as they relate to the practice of pediatric cardiology.     

Endothelin-1 and vascular tone in subjects with atherogenic risk factors

Endothelin-1 (ET-1) is a potent vasoconstrictor that increases vascular tone in the resistance vessels of subjects with hypertension. It is unclear whether endogenous ET-1 affects resistance-vessel function equally in patients with other cardiovascular risk factors. Vasoconstriction to ET-1 is mediated principally via the endothelin-A (ETA) receptor on vascular smooth muscle cells. Accordingly, we used an ETA-specific antagonist, BQ-123, to test the hypothesis that endogenous ET-1 increases vascular resistance selectively in subjects with hypertension compared with other risk factors. BQ-123 was infused at 100 nmol/min for 80 minutes into the brachial artery of 10 subjects with hypertension (mean+/-SEM arterial pressure, 106+/-5 mm Hg), 12 subjects with hypercholesterolemia (mean+/-SEM total cholesterol, 7.1+/-0.2 mmol/L), 10 active smokers (mean+/-SEM, 42+/-11 pack-years), and 11 healthy, age-matched individuals. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. BQ-123 dilated resistance arterioles in hypertensive subjects, with FBF's increasing by 46+/-7% from baseline (P<0.001). BQ-123 increased FBF to a lesser extent in hypercholesterolemic (24+/-5%, P<0.001) and healthy (20+/-8%, P=0.007) individuals but did not affect FBF significantly in smokers (10+/-8%, P=0.185). The vasodilator response in hypertensive subjects, but not in hypercholesterolemic patients or smokers, was significantly greater than that in healthy individuals (P=0.012). Endogenous ET-1, acting via the ETA receptor, increases resistance-vessel tone in subjects with hypertension more than in subjects with hypercholesterolemia or in smokers. These results indicate that ET-1 contributes more to the pathophysiology of hypertension than of other risk factors in subjects without overt atherosclerosis.