Dual endothelin receptor blockade with tezosentan markedly attenuates hypoxia-induced pulmonary vasoconstriction in a porcine model

Aim: Our aim was to test the hypothesis that dual endothelin receptor blockade with tezosentan attenuates hypoxia‐induced pulmonary vasoconstriction. Methods: Fourteen anaesthetized, ventilated pigs, with a mean ± SEM weight of 30.5 ± 0.6 kg, were studied, in normoxia (FiO₂ 0.21) and with tezosentan (5 mg kg^?1) infusion during (n = 7) or before (n = 7) hypoxia (FiO₂ 0.10). Results: Compared to normoxia, hypoxia increased (P < 0.05) pulmonary vascular resistance (PVR) by 3.4 ± 0.7 WU, mean pulmonary artery pressure by 13.7 ± 1.3 mmHg, mean right atrial pressure by 1.9 ± 0.4 mmHg and decreased (P < 0.02) systemic vascular resistance (SVR) by 5.2 ± 2.1 WU. Pulmonary capillary wedge pressure (PCWP), mean aortic blood pressure, heart rate, cardiac output, stroke volume and blood‐O₂‐consumption were unaltered (P = ns). Tezosentan infused during hypoxia, normalized PVR, decreased (P < 0.05) maximally mean pulmonary artery pressure by 7.5 ± 0.8 mmHg, SVR by 5.8 ± 0.7 WU, mean aortic blood pressure by 10.8 ± 3.0 mmHg and increased (P < 0.04) stroke volume by 8.5 ± 1.8 mL. Mean right atrial pressure, PCWP, heart rate, cardiac output and blood‐O₂‐consumption were unaltered (P = ns). Tezosentan infused before hypoxia additionally attenuated approx. 70% of the initial mean pulmonary artery pressure increase and abolished the PVR increase, without additionally affecting the other parameters. Conclusion: Dual endothelin receptor blockade during hypoxia attenuates the ‘sustained’ acute pulmonary vasoconstrictor response by reducing the mean pulmonary artery pressure increase by approx. 62% and by normalizing PVR. Pre‐treatment with tezosentan before hypoxia, additionally attenuates the initial hypoxia‐induced mean pulmonary artery pressure rise by approx. 70% and abolishes the PVR increase, during stable circulatory conditions, without affecting oxygenation.     

骨髓间充质干细胞治疗实验性肺动脉高压后肺组织结构的变化

目的： 探讨骨髓间充质干细胞(MMSCs）移植治疗肺动脉高压(PAH)后肺组织超微结构的变化。方法: 取SD大鼠的骨髓,经贴壁筛选法体外培养并纯化MMSCs,用Hoechst 33342荧光染料标记。实验动物随机分为3组: MMSCs移植治疗组（M组）、肺动脉高压模型组 (H组)和正常对照组 (C组)。M组采用野百合碱(50 mg·kg-1) 注射复制PAH模型成功后3周经舌下静脉移植5×109 cells/L MMSCs细胞悬液1 mL;H组复制PAH模型后3周移植 1 mL L-DMEM细胞培养液,C组在同时间注射等量L-DMEM液。饲养4周,观察各组动物一般情况、生存率、右心室收缩压、右心指数及肺小动脉的微观结构和超微结构的改变。结果: 实验动物移植MMSCs后,生存状况明显改善,食欲及活动增加,毛色顺滑、光亮,动物存活率为100％;而模型组动物活动明显减少、食欲下降,消瘦,体重下降或不增,在1月内相继死亡,死亡率为100％。各项指标检测结果显示,MMSCs移植组（M组）大鼠较单纯肺动脉高压组 (H组)右心室收缩压明显降低［移植组为(32.20±2.32)mmHg,而模型组为(48.30±1.56)mmHg,两者相比差异显著,P<0.05］,右心指数下降［移植组为(38.80±3.24)%,模型组为(45.10±3.43)%, 二者相比差异显著,P<0.05］,肺小动脉的重建和超微结构的血气屏障、线粒体、板层小体等改变均有明显改善,其结果接近正常对照组。结论: MMSCs移植后可通过形成新生血管建立侧枝循环,有效减轻野百合碱诱导的肺动脉高压和肺组织病变程度。     

Gax在肺动脉高压大鼠肺动脉中的表达变化

目的:使用低氧及野百合碱(monocrotaline,MCT)诱导的两种肺动脉高压(pulmonary arterialhypertension,PAH)大鼠模型,观察生长终止特异性同源盒(growth arrest-specific homeobox,Gax)在肺动脉的表达变化。方法:Sprague Dawley大鼠随机分为四组:低氧模型组(n=16)、低氧对照组(n=16)、MCT模型组(n=16)及MCT对照组(n=16)。采用插管法测定大鼠的右心室压力及肺动脉压力。右心室质量除以左心室和室间隔质量,计算右心肥厚指数。采用定量RT-PCR法测定肺动脉主干及肺组织Gax mRNA表达;采用Western免疫印迹法测定肺动脉主干Gax蛋白表达;免疫组织化学染色观测Gax在肺内的分布及表达变化。结果:低氧模型组及MCT模型组大鼠的右心压力、肺动脉压力及右心肥厚指数均显著高于相应对照组(P<0.01),两种模型大鼠的肺动脉血管均出现明显重构。与对照组比较,Gax mRNA在两种模型组大鼠的肺组织表达降低(P<0.05),而在肺动脉主干表达升高(P<0.05)。Gax蛋白在肺内主要表达在微小动脉。与对照组比较,两种模型组大鼠的肺动脉主干和肺微小动脉Gax蛋白表达均升高(P<0.05),而肺组织Gax蛋白表达下降(P<0.05)。结论:Gax主要表达在肺微小动脉,在PAH发生时表达上调。     

Preventive aerobic training exerts a cardioprotective effect on rats treated with monocrotaline

Pulmonary arterial hypertension (PAH) is a chronic disease which causes overload to the right ventricle. The effect of preventive training on cardiac remodelling in this condition is still unknown. This study aimed to evaluate the influence of preventive training on hypertrophy, heart function and gene expression of calcium transport proteins in rats with monocrotaline‐induced PAH. Thirty‐two male Wistar rats were randomly divided into four groups: S, sedentary control; T, trained control; SM, sedentary monocrotaline; and TM, trained monocrotaline. The preventive training protocol was performed on a treadmill for 13 weeks, five times/week. The first two weeks were adopted for adaptation to training with gradual increases in speed/time. The speed of the physical training from the third to tenth weeks was gradually increased from 0.9 to 1.1 km/h for 60 min. Next, monocrotaline was applied (60 mg/kg) to induce PAH and lactate threshold analysis performed to determine the training speeds. The training speed of the TM group in the following two weeks was 0.8 km/h for 60 min and the T = 0.9 km/h for 60 min; in the final two weeks, both groups trained at the same speed and duration 0.9 km/h, 60 min. Cardiac function was assessed through echocardiography, ventricular hypertrophy through histomorphometric analysis and gene expression through RT‐qPCR. Right cardiac function assessed through the peak flow velocity was SM = 75.5 cm/s vs. TM = 92.0 cm/s (P = 0.001), and ventricular hypertrophy was SM = 106.4 μm² vs. TM = 77.7 μm² (P = 0.004). There was a decrease in the gene expression of ryanodine S = 1.12 au vs. SM = 0.60 au (P = 0.02) without alterations due to training. Thus, we conclude that prior physical training exerts a cardioprotective effect on the right ventricle in the monocrotaline rat model.     

Estrogen Preserves Pulsatile Pulmonary Arterial Hemodynamics in Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is caused by extensive pulmonary vascular remodeling that increases right ventricular (RV) afterload and leads to RV failure. PAH predominantly affects women; paradoxically, female PAH patients have better outcomes than men. The roles of estrogen in PAH remain controversial, which is referred to as “the estrogen paradox”. Here, we sought to determine the role of estrogen in pulsatile pulmonary arterial hemodynamic changes and its impact on RV functional adaption to PAH. Female mice were ovariectomized and replenished with estrogen or placebo. PAH was induced with SU5416 and chronic hypoxia. In vivo hemodynamic measurements showed that (1) estrogen prevented loss of pulmonary vascular compliance with limited effects on the increase of pulmonary vascular resistance in PAH; (2) estrogen attenuated increases in wave reflections in PAH and limited its adverse effects on PA systolic and pulse pressures; and (3) estrogen maintained the total hydraulic power and preserved transpulmonary vascular efficiency in PAH. This study demonstrates that estrogen preserves pulmonary vascular compliance independent of pulmonary vascular resistance, which provides a mechanical mechanism for ability of estrogen to delay disease progression without preventing onset. The estrogenic protection of pulsatile pulmonary hemodynamics underscores the therapeutic potential of estrogen in PAH.     

氟西汀对BMPR2表达的影响以及对野百合碱诱导大鼠肺动脉高压的预防作用

目的探讨氟西汀对骨形态生成蛋白受体2(bone morphogenetic protein receptor 2,BMPR2)表达的影响以及对野百合碱(monocrotaline,MCT)诱导大鼠肺动脉高压(pulmonary arterial hypertension,PAH)的预防作用。方法将24只Wistar大鼠随机分成三组:对照组、MCT组和氟西汀处理组。采用多导生理记录仪测量血流动力学相关指标,HE染色方法观察肺动脉的形态学改变,以及利用RT-PCR方法检测肺动脉BMPR2的表达。结果与对照组相比,MCT组肺动脉压力、肺动脉中膜厚度百分比以及右心肥厚指数均明显升高,BMPR2在肺动脉上的表达明显减少(<0.01)。给予氟西汀处理后,氟西汀明显抑制了MCT诱发的肺动脉压力的升高、肺动脉重构和右心肥厚,并逆转了BMPR2的表达(<0.05)。结论肺动脉的构型重建可能与BMPR2的表达减少有关。氟西汀可能通过逆转BMPR2的表达有效地预防MCT诱导的PAH。     

Acute effects of pulmonary artery banding in sheep on right ventricle pressure–volume relations: relevance to the arterial switch operation

The first stage of the two‐stage arterial switch operation (ASO) for transposition of the great arteries (TGA) is associated with depressed ventricular function and an unstable immediate post‐operative course. It is unclear if this is because of the acute increase in afterload of the thin‐walled, low‐pressure ventricle by pulmonary artery banding (PAB). To determine the acute effects of afterload increase on the contractile function of thin‐walled ventricles, we studied the right ventricular pressure–volume relations of seven sheep before and 30 min after PAB using combined pressure–conductance catheters during inflow reduction. Load independent indices of systolic and diastolic performance were derived from these relations. Pulmonary artery banding increased the mean ratio between right and left ventricular systolic pressure from 0.34 ± 0.05 to 0.64 ± 0.10, P < 0.05 (mean ± SD). There were no significant changes in heart rate and end‐systolic volume after banding although there was an incremental trend in the end‐diastolic volume and stroke volume. Right ventricular output (530 ± 163–713 ± 295 mL min^–1, P < 0.05), slope of the end‐systolic pressure–volume relation (ESPVR) (3.7 ± 2.8–10.0 ± 4.8 mmHg mL^–1, P < 0.05) and slope of the pre‐load recruitable stroke work (PRSW) relation (9.6 ± 1.8–15.0 ± 3.1 mmHg, P < 0.05) were significantly increased indicating improved contractile state after banding. The diastolic function curve was unchanged after banding although the right ventricle (RV) was operating at a larger end‐diastolic volume. Hence, the RV of sheep responded to acute pressure overload by demonstrating enhanced contractility and evidence of the Frank–Starling mechanism without associated change in right ventricular diastolic performance.     

Obstructive sleep apnea is associated with worse clinical‐radiological risk scores of pulmonary embolism

Obstructive sleep apnea is a risk factor for pulmonary embolism, although its association with pulmonary embolism severity is unknown. Our objective was to study if obstructive sleep apnea is associated with worse pulmonary embolism severity scores and greater extent of arterial obstruction. In consecutive pulmonary embolism patients, we performed respiratory polygraphy and recorded sleep characteristics, classical risk factors for pulmonary embolism and physical activity 6–12 months after the pulmonary embolism episode. Simplified Geneva Prognostic Score and Pulmonary Embolism Severity Index were calculated at the time of the pulmonary embolism diagnosis. The Pulmonary Artery Obstruction Index and the right ventricle to left ventricle diameter ratio were measured by computed tomography pulmonary angiography. We included 120 patients, of whom 45.8% had moderate‐severe obstructive sleep apnea (apnea–hypopnea index > 15 hr^?1). There was a larger proportion of moderate‐severe obstructive sleep apnea patients in the third and fourth Pulmonary Artery Obstruction Index quartiles and in the III‐V Pulmonary Embolism Severity Index levels compared with apnea–hypopnea index < 15 hr^?1 group. However, no differences were found between the proportion of patients with or without moderate‐severe obstructive sleep apnea in their stratification by simplified Geneva Prognostic Score. The mean adjusted values of the simplified Geneva Prognostic Score, Pulmonary Embolism Severity Index and Pulmonary Artery Obstruction Index scores were higher in the apnea–hypopnea index > 15 hr^?1 group (p < .05). Multiple linear regression analysis identified apnea–hypopnea index as the only independent factor related to Pulmonary Artery Obstruction Index and Pulmonary Embolism Severity Index, whereas desaturation index was associated with simplified Geneva Prognostic Score. Patients with pulmonary embolism and moderate‐severe obstructive sleep apnea had greater pulmonary artery obstruction as well as more pulmonary embolism severity, assessed by both the simplified Geneva Prognostic Score and the Pulmonary Embolism Severity Index, compared with patients with apnea–hypopnea index ≤ 15 hr^?1. Moreover, these prognostic indices were independently related to sleep parameters.     

The principal pathways involved in the in vivo modulation of hypoxic pulmonary vasoconstriction,pulmonary arterial remodelling and pulmonary hypertension

Hypoxic pulmonary vasoconstriction (HPV) serves to optimize ventilation–perfusion matching in focal hypoxia and thereby enhances pulmonary gas exchange. During global hypoxia, however, HPV induces general pulmonary vasoconstriction, which may lead to pulmonary hypertension (PH), impaired exercise capacity, right‐heart failure and pulmonary oedema at high altitude. In chronic hypoxia, generalized HPV together with hypoxic pulmonary arterial remodelling, contribute to the development of PH. The present article reviews the principal pathways in the in vivo modulation of HPV, hypoxic pulmonary arterial remodelling and PH with primary focus on the endothelin‐1, nitric oxide, cyclooxygenase and adenine nucleotide pathways. In summary, endothelin‐1 and thromboxane A₂ may enhance, whereas nitric oxide and prostacyclin may moderate, HPV as well as hypoxic pulmonary arterial remodelling and PH. The production of prostacyclin seems to be coupled primarily to cyclooxygenase‐1 in acute hypoxia, but to cyclooxygenase‐2 in chronic hypoxia. The potential role of adenine nucleotides in modulating HPV is unclear, but warrants further study. Additional modulators of the pulmonary vascular responses to hypoxia may include angiotensin II, histamine, serotonin/5‐hydroxytryptamine, leukotrienes and epoxyeicosatrienoic acids. Drugs targeting these pathways may reduce acute and/or chronic hypoxic PH. Endothelin receptor antagonists and phosphodiesterase‐5 inhibitors may additionally improve exercise capacity in hypoxia. Importantly, the modulation of the pulmonary vascular responses to hypoxia varies between species and individuals, with hypoxic duration and age. The review also define how drugs targeting the endothelin‐1, nitric oxide, cyclooxygenase and adenine nucleotide pathways may improve pulmonary haemodynamics, but also impair pulmonary gas exchange by interference with HPV in chronic lung diseases.     

氟西汀对野百合碱诱导Wistar大鼠肺动脉和右心室构型重建的影响

目的 研究氟西汀对野百合碱(monocrotaline,MCT)诱导Wistar大鼠肺动脉和右心室构型重建的影响.方法 应用野百合碱建立大鼠肺动脉高压模型,40只Wistar大鼠均分为4组:对照组(control)、模型组(MCT)、氟西汀低剂量2mg/kg组(MCT+F2)和氟西汀高剂量lOmg/kg组(MCT+F1...     

ANP gene expression in rat hearts during hypoxia

 It is unclear whether the increase in plasma atrial natriuretic peptide (ANP) concentration during hypoxia is due to direct, hypoxia-induced upregulation of ANP secretion in the heart, or to pressure overload of the right ventricle (RV) following hypoxia-induced pulmonary hypertension. To test the hypothesis that hypoxia leads to an early upregulation of the ANP gene, we examined the influence of acute and prolonged inspiratory hypoxia (6 h, 1 or 3 weeks) on the expression of ANP messenger ribonucleic acid (mRNA) in rat heart and compared the results with the expression of the ANP gene after acute pressure overload induced by experimental coarctation of the main pulmonary artery. As a molecular marker for hypertrophy we determined the ratio of α- and β-myosin gene expression. Hypoxia increased systolic RV pressure from 20.0 ± 1.6 mmHg to 27.8 ± 1.6 mmHg (P < 0.01) and 41.6 ± 2.1 mmHg (P < 0.05) after 1 and 3 weeks hypoxia respectively. The ANP plasma concentration did not change significantly after 6 h or 1 week: 232 ± 21 pg/ml (control), 246 ± 25 pg/ml (6 h), 268 ± 25 pg/ml (1 week), but increased significantly after 3 weeks hypoxia (446.8 ± 99.56 pg/ml; P < 0.05). ANP mRNA levels in different regions of the heart did not change after 6 h or 1 week hypoxia. After 3 weeks hypoxia ANP mRNA had increased 2.7-fold in the RV (P < 0.05), 4.2-fold in the left ventricle (LV, P < 0.05), 3.5-fold in the septum (S, P < 0.05) and about 1.4-fold in the right (n.s.) and left atrium (n.s.). Relative ventricular masses increased significantly only for the RV (190%, P < 0.05) during hypoxia. The β/α-myosin mRNA ratio did not change after 6 h hypoxia but, contrary to ANP gene expression, increased after just 1 week (6.1-fold in RV, 7.8-fold in LV, 6-fold in S; P < 0.05) and was more pronounced in the RV after 3 weeks (9.4-fold in RV, 7.6-fold in LV, 9.1-fold in S; P < 0.05). The increase in the β/α-myosin mRNA ratio in the LV contrasts with a lack of increase in relative ventricular mass. Acute pressure overload in the RV after pulmonary arterial banding significantly increased ANP-mRNA and the β/α-myosin mRNA ratio after 1 day in the RV. In the LV ANP mRNA was unchanged. The delayed upregulation of the ANP gene suggests that hypoxia per se is not a significant stimulus for ANP gene expression in the heart and that hypoxia-induced ANP-gene expression in the heart is regulated predominantly by the increase in RV afterload due to hypoxia-induced increased pulmonary pressure. The upregulation of ANP and β-myosin mRNA in the LV during chronic hypoxia has yet to be elucidated. Received: 5 November 1996 / Received after revision and accepted: 24 January 1997     

Endogenous NO does not regulate baseline pulmonary pressure,but reduces acute pulmonary hypertension in dogs

It has remained unclear whether endogenous production of nitric oxide (NO) plays an important role in the regulation of physiologically normal pulmonary pressures. Severe alveolar hypoxia is accompanied by decreased pulmonary NO production, which could contribute to the development of hypoxic pulmonary hypertension. On the other hand, pharmacological NO inhibition further augments this hypertensive response. Aims: The aims of the present study were to test: (a) whether NO contributes importantly in the maintenance of baseline pulmonary pressure; and (b) to which degree NO is involved in the pulmonary haemodynamic adjustments to alveolar hypoxia. Methods: In anaesthetized dogs (n = 37), the systemic and pulmonary haemodynamic effects of the NO synthase inhibitor, N^ω‐nitro‐l ‐arginine methyl ester (l ‐NAME, 20 mg kg^?1) and substrate, l ‐arginine (200–500 mg kg^?1), were determined at baseline and during alveolar hypoxia. Constant blood flows were accomplished by biventricular bypass, and systemic normoxaemia was maintained by extracorporeal oxygenation. Results: The primary findings were: (a) l ‐NAME failed to increase baseline mean pulmonary arterial pressure (10.1 ± 0.7 vs. 10.5 ± 0.5 mmHg, P = ns), despite effective NO synthase inhibition as evidenced by robust increases in systemic arterial pressures; (b) l ‐NAME augmented the pulmonary hypertensive response to alveolar hypoxia (10.2 ± 0.7 to 19.5 ± 1.7 with l ‐NAME vs. 9.9 ± 1.1 to 15.5 ± 1.0 mmHg without l ‐NAME, P < 0.05); and (c) l ‐arginine failed to decrease baseline or elevated pulmonary pressures. Instead, prolonged l ‐arginine caused increases in pulmonary pressure. Conclusion: These findings suggest that NO plays no significant role in the tonic physiological control of pulmonary pressure, but endogenous NO becomes an important vasodilatory modulator during elevated pulmonary pressure.     

Middle cerebral artery blood velocity depends on cardiac output during exercise with a large muscle mass

We tested the hypothesis that pharmacological reduction of the increase in cardiac output during dynamic exercise with a large muscle mass would influence the cerebral blood velocity/perfusion. We studied the relationship between changes in cerebral blood velocity (transcranial Doppler), rectus femoris blood oxygenation (near-infrared spectroscopy) and systemic blood flow (cardiac output from model flow analysis of the arterial pressure wave) as induced by dynamic exercise of large (cycling) vs. small muscle groups (rhythmic handgrip) before and after cardioselective β₁ adrenergic blockade (0.15 mg kg^?1 metoprolol i.v.). During rhythmic handgrip, the increments in systemic haemodynamic variables as in middle cerebral artery mean blood velocity were not influenced significantly by metoprolol. In contrast, during cycling (e.g. 113 W), metoprolol reduced the increase in cardiac output (222 ± 13 vs. 260 ± 16%), heart rate (114 ± 3 vs. 135 ± 7 beats min^?1) and mean arterial pressure (103 ± 3 vs.112 ± 4 mmHg), and the increase in cerebral artery mean blood velocity also became lower (from 59 ± 3 to 66 ± 3 vs. 60 ± 2 to 72 ± 3 cm s^?1; P < 0.05). Likewise, during cycling with metoprolol, oxyhaemoglobin in the rectus femoris muscle became reduced (compared to rest; ?4.8 ± 1.8 vs. 1.2 ± 1.7 μmol L^?1, P < 0.05). Neither during rhythmic handgrip nor during cycling was the arterial carbon dioxide tension affected significantly by metoprolol. The results suggest that as for the muscle blood flow, the cerebral circulation is also affected by a reduced cardiac output during exercise with a large muscle mass.     

缺氧性肺动脉高压大鼠右心室重构

摘要目的：研究缺氧性肺动脉高压大鼠右心室重构情况。方法：常压间断缺氧法复制缺氧性肺动脉高压大鼠模型，采用右心导管法测定平均肺动脉压力，通过测量右心室流入及流出道长度、左心室壁和右心室壁厚度、右心室和左心室 室间隔重量对其右心室重构情况进行定性研究。结果：缺氧14d后大鼠平均肺动脉压力显著升高，右心室流出道长度及右心室肥大指数显著增加，缺氧21d后右心室游离壁重量显著增加；右心室流人道长度及左、右心室壁厚度与对照组无统计学差异。结论：缺氧性肺动脉高压大鼠右心室早期表现为离心性肥大。     

Impact of Pulmonary Hypertension on Tricuspid Valve Function

Pulmonary arterial hypertension (PAH) results in increased right ventricle (RV) afterload leading to RV remodeling, tricuspid regurgitation (TR), and RV failure. Though characterizing the mechanisms of TR in PAH may suggest new treatment strategies, the mechanisms leading to TR in PAH have not been characterized. In the present study, eleven porcine tricuspid valves were studied in an in vitro right heart simulator. Annular dilatations of 1.2 and 1.4 times normal area, papillary muscle (PM) displacement simulating concentric RV dilatation and eccentric RV dilatation due to concomitant left ventricle dysfunction, and two levels of PAH hemodynamics were simulated independently and in combination. Relative TR, tenting area (TA) along each coaptation line, and coaptation area (CA) of each leaflet were quantified. Results showed a significant increase (p ≤ 0.05) in TR with both increased mean pulmonary artery pressure (mPAP) and annular dilatation of 1.4 times normal. Increased mPAP significantly decreased TA but tended to increase CA, while PM displacement significantly increased TA but did not affect CA, suggesting competing effects of transvalvular pressure and leaflet tethering. Annular dilatation significantly decreased anterior and posterior CA but did not affect TA. These results may inform future TV repairs in PAH to reduce TR and improve RV hemodynamics.     

磷酸肌醇3－激酶调控缺氧诱导因子1α对大鼠缺氧性肺动脉高压的作用

目的:观察缺氧性肺动脉高压（HPH）大鼠肺组织中蛋白激酶B（AKT））和缺氧诱导因子1α(HIF-1α)以及血管内皮生长因子(VEGF)的表达，探讨磷酸肌醇3-激酶（PI3K）通路与HIF-1α和VEGF的关系及其在HPH发病中的可能机制。 方法:40只成年雄性Wistar大鼠随机分成对照组、低氧3、7、14和21 d组，每组8只，测各组大鼠平均肺动脉压（mPAP）、右室肥大指数（RVHI）、血管形态学指标Western印迹检测磷酸化AKT(P-AKT)；原位杂交和免疫组化检测HIF-1α的表达。免疫组化检测P-AKT和VEGF水平。 结果:① 低氧7 d起大鼠mPAP、管壁厚度与血管外径比值及管壁面积与血管面积比值分别为(23.53 ±1.78)mmHg, (45.5±3.1)%和(54.7±3.2)%,与对照组［(16.15±1.97)mmHg、(36.8±2.5)%、(63.2±2.5)%］比较差异显著(P＜0.05),低氧14 d起稳定于高水平;低氧14 d RVHI为(26.5±2.9)%,与对照组［(22.9±2.2)%］比较差异也显著(P＜0.05)。②p-AKT蛋白在对照组表达不明显，缺氧3 d后表达上升，与对照组比较差异显著(P＜0.05)，且在缺氧3 d、7 d、14 d、21 d组肺小动脉内膜、中膜表达均为阳性。③HIF-1α蛋白对照组表达不明显，缺氧3 d、7 d、14 d、21 d组肺血管内膜均为阳性，肺血管中膜，缺氧3 d组表达开始升高（0.209±0.009），与对照组比较差异显著(P＜0.05),缺氧7 d达高峰（0.232±0.008,P＜0.05），14 d和21 d下降；HIF-1α mRNA在对照组肺动脉血管壁内表达弱阳性，缺氧3 d和7 d肺血管中表达无明显变化，与对照组比较差异无显著(P＞0.05)。缺氧14 d后表达增高(0.305±0.104, P＜0.05),并持续维持于高水平。VEGF蛋白水平在低氧7 d显著高于对照组(0.188±0.018, P<0.05),14 d达高峰(0.238±0.017, P<0.05)。相关分析表明mPAP与肺血管重塑呈正相关(r=0.983, P<0.01)。在肺小血管内膜:P-AKT与 HIF-1α蛋白呈正相关(r=0.883, P<0.01)， HIF-1α与VEGF蛋白呈正相关(r=0.897, P<0.01)。 结论:磷酸化AKT与HIF-1α和VEGF均在大鼠HPH的发病机制中发挥作用。磷酸化AKT可能通过使HIF-1α蛋白表达增加的方式上调HIF-1α，进而上调下游目标基因VEGF，导致HPH的发生和发展。     

Evaluation of autologous blood clot subsegmental pulmonary thromboembolism in minimally invasive experimental canine model

The incidence and significance of subsegmental pulmonary (SSP) thromboembolism is currently under investigation. We aimed to evaluate the clinical and diagnostic features of SSP thromboembolism in an experimental canine model. Obstruction of pulmonary arterial branches was induced in three beagle dogs by intravenous injection of a barium‐coated autologous blood clot (size, approximately 1.7 × 5 mm). The clinical signs, haemodynamic changes (blood pressure, electrocardiogram, echocardiography), coagulation (aPTT, PT, FDPs and D‐dimer test) and cytokine variations (TNF‐a, IL‐4, IL‐6, and IL‐10) were evaluated over a 24‐hour period. Multidetector computed tomography (MDCT) with contrast was conducted to evaluate the pulmonary obstruction, and histopathological confirmation was performed. Pulmonary artery pressure gradient (PAPG) was increased 12 h after the autologous blood clot injection (14.2 ± 2.8 mmHg to 23.6 ± 1.7 mmHg, P = 0.003) and normalized 24 h later (P < 0.01). Infused radiopaque clots were confirmed with MDCT and histopathological examination. Pulmonary parenchymal changes such as arterial dilation and inflammatory reactions were also confirmed in histopathological examinations and were barely observable in MDCT. Usually small emboli are not easily detected through CT imaging, and the clinical relevance of these emboli is controversial. In this experimental study, we made radiopaque small emboli and induced SSP thromboembolism. Thus, we infer that obstruction of the small segmental and subsegmental pulmonary arteries does result in a pulmonary thromboembolism (PTE) and PTE‐related pulmonary parenchymal changes which could be clinically significant.     

Contribution of calcium-activated chloride channel to elevated pulmonary artery pressure in pulmonary arterial hypertension induced by high pulmonary blood flow

The correlation between calcium-activated chloride channel (CaCC) and pulmonary arterial hypertension (PAH) induced by high pulmonary blood flow remains uncertain. In this study, we investigated the possible role and effects of CaCC in this disease. Sixty rats were randomly assigned to normal, sham, and shunt groups. Rats in the shunt group underwent abdominal aorta and inferior vena cava shunt surgery. The pulmonary artery pressure was measured by catheterization. Pathological changes, right ventricle hypertrophy index (RVHI), arterial wall area/vessel area (W/V), and arterial wall thickness/vessel external diameter (T/D) were analyzed by optical microscopy. Electrophysiological characteristics of pulmonary arterial smooth muscle cells (PASMCs) were investigated using patch clamp technology. After 11 weeks of shunting, PAH and pulmonary vascular structural remodeling (PVSR) developed, accompanied by increased pulmonary pressure and pathological interstitial pulmonary changes. Compared with normal and sham groups, pulmonary artery pressure, RVHI, W/V, and T/D of the shunt group rats increased significantly. Electrophysiological results showed primary CaCC characteristics. Compared with normal and sham groups, membrane capacitance and current density of PASMCs in the shunt group increased significantly, which were subsequently attenuated following chloride channel blocker niflumic acid (NFA) treatment. To conclude, CaCC contributed to PAH induced by high pulmonary blood flow and may represent a potential target for treatment of PAH.     

雾化吸入亚硝酸钠对低氧性肺动脉高压大鼠肺动脉压力及NO、H_2S水平的影响

目的:探讨雾化吸入一氧化氮供体亚硝酸钠(NaNO2)后对低氧性肺动脉高压(HPH)大鼠肺动脉压力及体内一氧化氮(NO)、硫化氢(H2S)水平的影响。方法:雄性Wistar大鼠50只,随机分为常氧空白组、常氧亚硝酸钠组、低氧空白组、低氧生理盐水组、低氧亚硝酸钠组,采用常压低氧法建立大鼠HPH动物模型。测定肺动脉平均压(mPAP)、右室重量、左室+室间隔重量并计算右心室肥厚指数(RVHI=RV/LV+S);血清及肺匀浆NO含量、血浆H2S水平测定;光镜观察肺小动脉结构改变,弹力纤维+VG染色观察弹力纤维、肌纤维及胶原纤维增生情况。结果:低氧前各组大鼠体重无差别,而低氧后大鼠体重差别显著(P0.05);低氧各组大鼠的mPAP、RVHI值与常氧各组相比均升高,低氧亚硝酸钠与低氧空白组和低氧生理盐水组比较,mPAP和RV/(LV+S)值降低(P0.05);血清中NO水平低氧各组较常氧各组均降低(P0.05);肺组织匀浆中NO水平:低氧空白组和低氧生理盐水组较常氧各组降低(P0.05);而低氧亚硝酸钠组与常氧空白组比较无显著差异(P0.05);血中H2S水平:低氧各组均较常氧各组降低(P0.05);低氧亚硝酸钠组与低氧空白组、低氧生理盐水组比较升高(P0.05)。光镜下,常氧空白组管腔结构正常;常氧亚硝酸钠组未见明显变化;低氧空白组肺小动脉平滑肌增生,胶原纤维增多,管壁增厚,管腔狭窄;低氧生理盐水组变化同低氧空白组;低氧亚硝酸钠组管壁狭窄较低氧空白组有所减少。结论:雾化吸入亚硝酸钠能有效降低肺动脉压力,减轻右室重构,可调节大鼠体内NO、H2S水平,可能通过直接作用或在体内影响气体信号分子的分泌及合成来实现对HPH的防治。     

Responses of the bronchial and pulmonary circulations to short‐term nitric oxide inhalation before and after endotoxaemia in the pig

The physiological responses of the bronchial circulation to acute lung injury and endotoxin shock are largely unexplored territory. This study was carried out to study the responsiveness of the bronchial circulation to nitric oxide (NO) inhalation before and after endotoxaemia, in comparison with the pulmonary circulation, as well as to study changes in bronchial blood flow during endotoxaemia. Six anaesthetized pigs (pre‐treated with the cortisol‐synthesis inhibitor metyrapone) received an infusion of 10 µg/kg endotoxin during 2 h. Absolute bronchial blood flow was measured via an ultrasonic flow probe around the bronchial artery. The pigs received increasing doses of inhaled NO over 5 min each (0, 0.2, 2 and 20 ppm) before and after 4 h of endotoxaemia. The increase in bronchial vascular conductance during 5 min of inhalation of 20 ppm NO before endotoxin shock was significantly higher (area under curve (AUC) 474.2 ± 84.5% change) than after endotoxin shock (AUC 118.2 ± 40.4%, P < 0.05 Mann–Whitney U‐test). The reduction of the pulmonary arterial pressure by 20 ppm NO was not different. A short rebound effect of the pulmonary arterial pressure occurred after discontinuation of inhaled NO before endotoxaemia (AUC values above baseline 54.4 ± 19.7% change), and was virtually abolished after endotoxaemia (AUC 6.1 ± 4.0%, P = 0.052, Mann–Whitney U‐test). Our results indicate that the responsiveness of the bronchial circulation to inhalation of increasing doses of inhaled NO during endotoxin shock clearly differ from the responsiveness of the pulmonary circulation. The reduced responsiveness of the bronchial circulation is probably related to decreased driving pressure for the bronchial blood flow. The absence of the short rebound effect on pulmonary arterial pressure (PAP) after induction of shock could be related to maximum constriction of the pulmonary vessels at 4 h.